Provider Demographics
NPI:1003003427
Name:MCEWAN, JENNIFER (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCEWAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 HUNTINGTON AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1448
Mailing Address - Country:US
Mailing Address - Phone:703-765-1400
Mailing Address - Fax:
Practice Address - Street 1:2560 HUNTINGTON AVE STE 302
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-1448
Practice Address - Country:US
Practice Address - Phone:703-765-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-30
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical