Provider Demographics
NPI:1659501328
Name:REISWEBER, JARROD ROBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JARROD
Middle Name:ROBERT
Last Name:REISWEBER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3615
Mailing Address - Country:US
Mailing Address - Phone:215-668-9418
Mailing Address - Fax:
Practice Address - Street 1:798 SOUTHPARK BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3615
Practice Address - Country:US
Practice Address - Phone:215-668-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical