Provider Demographics
NPI:1588799514
Name:JURRENS, EMMA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:B
Last Name:JURRENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2010 WAVE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2511
Mailing Address - Country:US
Mailing Address - Phone:540-446-9805
Mailing Address - Fax:540-657-1439
Practice Address - Street 1:1320 CENTRAL PARK BLVD
Practice Address - Street 2:SUITE 231
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4942
Practice Address - Country:US
Practice Address - Phone:540-446-6567
Practice Address - Fax:540-657-1439
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810003385103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11505138OtherCAQH CREDENTIALING ID
VA0810003385OtherHEALTH PROFESSION LICENSE
185172OtherANTHEM BLUE CROSS BLUE SH
185172OtherANTHEM BLUE CROSS BLUE SH