Provider Demographics
NPI:1528371374
Name:GILBERT, JENNIFER L (PSYD, LCP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:HINESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LCP
Mailing Address - Street 1:PO BOX 780125
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0125
Mailing Address - Country:US
Mailing Address - Phone:804-922-4844
Mailing Address - Fax:
Practice Address - Street 1:1001 E LEIGH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5004
Practice Address - Country:US
Practice Address - Phone:804-828-5883
Practice Address - Fax:804-828-5399
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical