Provider Demographics
NPI:1831636950
Name:PEARLSTEIN, JESSE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:PEARLSTEIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 CHAMBERLAYNE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2407
Mailing Address - Country:US
Mailing Address - Phone:804-272-2000
Mailing Address - Fax:804-272-2030
Practice Address - Street 1:3321 PATTERSON AVE
Practice Address - Street 2:APT 5
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2364
Practice Address - Country:US
Practice Address - Phone:434-906-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040097661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical