Provider Demographics
NPI:1770608150
Name:GEORGE, JENNIFER FABRIZIO (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FABRIZIO
Last Name:GEORGE
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:VA PITTSBURGH HEALTHCARE SYSTEM
Mailing Address - Street 2:UNIVERSITY DRIVE, MAIL STOP 116 A-U
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15240
Mailing Address - Country:US
Mailing Address - Phone:412-360-6506
Mailing Address - Fax:412-360-2996
Practice Address - Street 1:VA PITTSBURGH HEALTHCARE SYSTEM
Practice Address - Street 2:UNIVERSITY DRIVE, MAIL STOP 116 A-U
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240
Practice Address - Country:US
Practice Address - Phone:412-360-6506
Practice Address - Fax:412-360-2996
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
580550-000OtherMAGELLAN HEALTH SERVICES
04322OtherPARAMOUNT HEALTH CARE
OHFACP30941Medicare ID - Type Unspecified
OHFACP30942Medicare ID - Type Unspecified