Provider Demographics
NPI:1679632798
Name:UNTERBERG, JENNIFER BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BETH
Last Name:UNTERBERG
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 1:3131 TURTLE CREEK BLVD
Mailing Address - Street 2:SUITE 1026
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5405
Mailing Address - Country:US
Mailing Address - Phone:214-770-5030
Mailing Address - Fax:214-522-0946
Practice Address - Street 1:3131 TURTLE CREEK BLVD
Practice Address - Street 2:SUITE 1026
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5405
Practice Address - Country:US
Practice Address - Phone:214-770-5030
Practice Address - Fax:214-522-0946
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32563103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613339Medicare PIN