Provider Demographics
NPI:1568401123
Name:MORGAN, JENNIFER MERLE (PSYD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MERLE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MERLE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:9202 CENTER OAK CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2744
Mailing Address - Country:US
Mailing Address - Phone:804-730-0432
Mailing Address - Fax:804-730-2829
Practice Address - Street 1:9202 CENTER OAK CT
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-730-0432
Practice Address - Fax:804-730-2829
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001987103TC0700X, 103G00000X
GAPSY002693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA292204OtherANTHEM BCBS
VA007713169Medicaid
VA007713177Medicaid
VA083502OtherSENTARA MENTAL HEALTH
VA292204OtherANTHEM BCBS
680001596Medicare ID - Type Unspecified