DR. JACK KITAEFF PH.D.
NPI 1518300201
Psychologist - Clinical in Fairfax, VA

Q: What is Jack Kitaeff's NPI number?

The NPI number for Jack Kitaeff is 1518300201. It was assigned to this individual provider in the NPPES registry on April 11, 2013.

Q: What is Jack Kitaeff's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Jack Kitaeff was last updated on September 29, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 11, 2013PECOS EnrolledAccepts Medicare Assignment

10560 MAIN ST, SUITE 518, FAIRFAX, VA 22030(703) 349-2999 Get Directions Write a Review

NPPES record last updated: September 29, 2016. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About Dr. Jack Kitaeff Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACK KITAEFF PH.D. (NPI 1518300201) is an individual clinical provider in Fairfax, Virginia, licensed in Virginia (1070) and active in the NPI registry since April 2013. He is enrolled in Medicare PECOS and is a graduate of University Of Mississippi School Of Medicine (1978).

NPPES Registry Identity

NPI1518300201

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameDR. JACK KITAEFFCredential: PH.D.

Location Address10560 MAIN ST, SUITE 518Fairfax, VA 22030-7182

Mailing Address9020 Fort Craig DrBurke, VA 22015-2115 · (703) 501-0129

Phone(703) 349-2999

Sole ProprietorYes

Medical School CMSUniversity Of Mississippi School Of MedicineGraduated 1978

Enumeration DateApril 11, 2013

Last NPPES UpdateSeptember 29, 2016

✔ NPI 1518300201 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in VA · 1070

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

10560 MAIN ST, Fairfax, VA 22030

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Jack Kitaeff Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6608132261

PECOS Enrollment IDI20171114003674

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22030 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$194.86 typical visit price

range $65.18 – $194.86

Typical copayment $48.71 (range $16.29 – $48.71)

Most-billed visit code 99205

Established Patient

$113.72 typical visit price

range $21.40 – $158.88

Typical copayment $28.43 (range $5.35 – $39.72)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TARA LEIGH REYNOLDS

Psychologist (Clinical)

10560 MAIN ST, SUITE 518
FAIRFAX, VA 22030

Fairfax City (703) 349-2999

FATINA SMITH LCSW

Social Worker (Clinical)

10560 MAIN ST, SUITE 317
FAIRFAX, VA 22030

Fairfax City (703) 728-8329

JEANNE MARIE MARQUIS PHD

Psychologist (Clinical)

10560 MAIN ST, STE 507
FAIRFAX, VA 22030

Fairfax City (703) 691-1326

SHEILA BURLINGTON FINNERTY R.N., L.C.S.W.

Counselor (Mental Health)

10560 MAIN ST, SUITE 410
FAIRFAX, VA 22030

Fairfax City (703) 352-8534

THE ARBOR CENTER

Marriage & Family Therapist

10560 MAIN ST, SUITE 410
FAIRFAX, VA 22030

Fairfax City (703) 352-8900

ACCUMEDS HOME CARE LLC

Respite Care

10560 MAIN ST, SUITE 112
FAIRFAX, VA 22030

Fairfax City (703) 371-1344

DR. BARRY N BURIJON PHD

Psychologist

10560 MAIN ST, SUITE 507
FAIRFAX, VA 22030

Fairfax City (703) 691-1326

MELISSA DIANNE ADDESSI LPC

Counselor (Mental Health)

10560 MAIN ST
FAIRFAX, VA 22030

Fairfax City (571) 264-8192

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Kitaeff's NPI number?

The NPI number for Jack Kitaeff is 1518300201. It was assigned to this individual provider in the NPPES registry on April 11, 2013.

Where is Jack Kitaeff located?

Jack Kitaeff practices at 10560 Main St Suite 518, Fairfax, VA 22030. The listed phone number is (703) 349-2999.

What is Jack Kitaeff's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Jack Kitaeff enrolled in Medicare?

Yes. Jack Kitaeff is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Jack Kitaeff was last updated on September 29, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.