Provider Demographics
NPI:1114302601
Name:FLAHERTY, JENNIFER MAROLA (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAROLA
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:MAROLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8400
Mailing Address - Fax:757-446-8401
Practice Address - Street 1:825 FAIRFAX AVE STE 710
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5888
Practice Address - Fax:757-446-5918
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005254103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1114302601OtherCIGNA BEHAVIORAL HEALTH
VA1114302601OtherANTHEM BEHAVIORAL HEALTH
VA1114302601OtherVIRGINIA PREMIER HEALTH PLAN
VA1114302601OtherAETNA BEHAVIORAL HEALTH
VA1114302601OtherMANAGED HEALTH NETWORK
VA1114302601OtherVIRGINIA HEALTH NETWORK
VA1114302601OtherOPTIMA BEHAVIORAL HEALTH
VA1114302601OtherUSA MANAGED CARE
VA1114302601OtherCORVEL
VA1114302601OtherMULTIPLAN
VA1114302601OtherMAGELLAN HEALTHCARE
VA1114302601OtherUNITED BEHAVIORAL HEALT
VA1114302601Medicaid
VA1114302601OtherUNITED BEHAVIORAL HEALT