Healthcare Provider Details

I. General information

NPI: 1346572351
Provider Name (Legal Business Name): JILL ALLISON FERRANTE GASPER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 LIBBIE AVE SUITE 100
RICHMOND VA
23226-2618
US

IV. Provider business mailing address

508 LIBBIE AVE SUITE 100
RICHMOND VA
23226-2618
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-1800
  • Fax:
Mailing address:
  • Phone: 804-282-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810004133
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: