Provider Demographics
NPI:1114211893
Name:BEARD, JENNIFER BLAIR (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BLAIR
Last Name:BEARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BLAIR
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 BRANDON AVE
Mailing Address - Street 2:BOX 800760
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0760
Mailing Address - Country:US
Mailing Address - Phone:434-243-5180
Mailing Address - Fax:434-243-5188
Practice Address - Street 1:400 BRANDON AVE
Practice Address - Street 2:BOX 800760
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0760
Practice Address - Country:US
Practice Address - Phone:434-243-5180
Practice Address - Fax:434-243-5188
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004602103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling