Provider Demographics
NPI:1568570091
Name:REPPUCCI, CHRISTINE MARLOW (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARLOW
Last Name:REPPUCCI
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 1:420 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4620
Mailing Address - Country:US
Mailing Address - Phone:434-979-0671
Mailing Address - Fax:434-979-1762
Practice Address - Street 1:420 3RD ST NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4620
Practice Address - Country:US
Practice Address - Phone:434-979-0671
Practice Address - Fax:434-979-1762
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA060405OtherANTHEM BLUE CROSS/BLUE SH
VA082270OtherSENTARA BEHAVIORAL HEALTH
VA7727798Medicaid