Healthcare Provider Details

I. General information

NPI: 1134259757
Provider Name (Legal Business Name): SARAH DEW-REEVES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12412 SAN JOSE BLVD SUITE 203
JACKSONVILLE FL
32223-8621
US

IV. Provider business mailing address

12412 SAN JOSE BLVD SUITE 203
JACKSONVILLE FL
32223-8621
US

V. Phone/Fax

Practice location:
  • Phone: 904-432-3321
  • Fax: 904-432-3324
Mailing address:
  • Phone: 904-432-3321
  • Fax: 904-432-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY 9064
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: