Provider Demographics
NPI:1265549273
Name:STEWARD, JEANNETTE MARIE (PHD)
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:MARIE
Last Name:STEWARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 HERITAGE VILLIAGE PLAZA
Mailing Address - Street 2:STE 102
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4422
Mailing Address - Country:US
Mailing Address - Phone:703-330-0304
Mailing Address - Fax:703-754-0311
Practice Address - Street 1:7230 HERITAGE VILLIAGE PLAZA
Practice Address - Street 2:STE 102
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4422
Practice Address - Country:US
Practice Address - Phone:703-330-0304
Practice Address - Fax:703-754-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical