Healthcare Provider Details

I. General information

NPI: 1639514078
Provider Name (Legal Business Name): JACQUELINE PACELLA JASPER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE MARJORIE PACELLA PSYD

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 KING ST
ALEXANDRIA VA
22314-2926
US

IV. Provider business mailing address

107 S WEST ST # 519
ALEXANDRIA VA
22314-2824
US

V. Phone/Fax

Practice location:
  • Phone: 571-478-9499
  • Fax:
Mailing address:
  • Phone: 571-478-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810007512
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: