Provider Demographics
NPI:1568712065
Name:DZIERZEWSKI, ROXANNE BAYAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:BAYAN
Last Name:DZIERZEWSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ROXANNE
Other - Middle Name:NONA
Other - Last Name:BAYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1901 HUGUENOT RD STE 305
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4311
Mailing Address - Country:US
Mailing Address - Phone:804-859-1966
Mailing Address - Fax:
Practice Address - Street 1:1901 HUGUENOT RD STE 305
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-859-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005033103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical