Provider Demographics
NPI:1639514078
Name:JASPER, JACQUELINE PACELLA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:PACELLA
Last Name:JASPER
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:MARJORIE
Other - Last Name:PACELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:107 S WEST ST # 519
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2824
Mailing Address - Country:US
Mailing Address - Phone:571-478-9499
Mailing Address - Fax:
Practice Address - Street 1:1221 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2926
Practice Address - Country:US
Practice Address - Phone:571-478-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist