Healthcare Provider Details

I. General information

NPI: 1609889880
Provider Name (Legal Business Name): JENNINE LOWE MORITZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 MONUMENT AVE STE 202
RICHMOND VA
23220-2943
US

IV. Provider business mailing address

1617 MONUMENT AVE STE 202
RICHMOND VA
23220-2943
US

V. Phone/Fax

Practice location:
  • Phone: 804-442-7192
  • Fax: 804-477-3226
Mailing address:
  • Phone: 804-442-7196
  • Fax: 804-477-3226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810002077
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: