Provider Demographics
NPI:1689938045
Name:BREWER, JENNIFER (BS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14396 WESTMINISTER LN APT 34
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3059
Mailing Address - Country:US
Mailing Address - Phone:440-320-4054
Mailing Address - Fax:
Practice Address - Street 1:12656 LAKE RIDGE DR STE C
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7504
Practice Address - Country:US
Practice Address - Phone:703-910-4362
Practice Address - Fax:703-910-4367
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst