Provider Demographics
NPI:1457599524
Name:BAGSBY, JENNIFER E (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:BAGSBY
Suffix:
Gender:F
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:PO BOX 1997
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-0997
Mailing Address - Country:US
Mailing Address - Phone:804-732-1527
Mailing Address - Fax:804-732-8210
Practice Address - Street 1:43 RIVES RD
Practice Address - Street 2:SUITE B
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9255
Practice Address - Country:US
Practice Address - Phone:804-732-1527
Practice Address - Fax:804-731-8210
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040068661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08729Medicare PIN