Provider Demographics
NPI:1952469009
Name:RABINOWITZ, JESSE A (PHD)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:A
Last Name:RABINOWITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BOULDERS PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225
Mailing Address - Country:US
Mailing Address - Phone:804-320-7881
Mailing Address - Fax:804-560-3474
Practice Address - Street 1:1000 BOULDERS PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225
Practice Address - Country:US
Practice Address - Phone:804-320-7881
Practice Address - Fax:804-560-3474
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007708301Medicaid
VA014873J42Medicare PIN
VA007708301Medicaid