Provider Demographics
NPI:1851622369
Name:ROBERTS, JESSICA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:C
Last Name:ROBERTS
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 1:57 MALVERN AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2667
Mailing Address - Country:US
Mailing Address - Phone:785-865-3597
Mailing Address - Fax:
Practice Address - Street 1:1300 E MARSHALL ST
Practice Address - Street 2:NORTH HOSPITAL, 2ND FLOOR, ROOM B2007
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5054
Practice Address - Country:US
Practice Address - Phone:804-628-8758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810004198OtherCOMMONWEALTH OF VIRGINIA, DEPARTMENT OF HEALTH PROFESSIONS, BOARD OF PSYCHOLOGY