Healthcare Provider Details

I. General information

NPI: 1831636950
Provider Name (Legal Business Name): JESSE PEARLSTEIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 PATTERSON AVE APT 5
RICHMOND VA
23221-2364
US

IV. Provider business mailing address

5408 CHAMBERLAYNE RD
RICHMOND VA
23227-2407
US

V. Phone/Fax

Practice location:
  • Phone: 434-906-5299
  • Fax:
Mailing address:
  • Phone: 804-272-2000
  • Fax: 804-272-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009766
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: