Healthcare Provider Details

I. General information

NPI: 1760598312
Provider Name (Legal Business Name): JILL PARKS WEBER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7927 JONES BRANCH DR SUITE: 6125
MC LEAN VA
22102-3322
US

IV. Provider business mailing address

7927 JONES BRANCH DR SUITE: 6125
MC LEAN VA
22102-3322
US

V. Phone/Fax

Practice location:
  • Phone: 703-541-1277
  • Fax: 703-992-0993
Mailing address:
  • Phone: 703-541-1277
  • Fax: 703-992-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003470
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: