Provider Demographics
NPI:1790518660
Name:CEDAR GROVE PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:CEDAR GROVE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:804-821-0770
Mailing Address - Street 1:405 E. LABURNUM AVE. STE 3 #373
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222
Mailing Address - Country:US
Mailing Address - Phone:804-821-0770
Mailing Address - Fax:
Practice Address - Street 1:405 E. LABURNUM AVENUE
Practice Address - Street 2:STE 3, #373
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222
Practice Address - Country:US
Practice Address - Phone:804-821-0770
Practice Address - Fax:804-821-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty