Healthcare Provider Details

I. General information

NPI: 1679554364
Provider Name (Legal Business Name): JEWEL VICTORIA OWEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BARREN SPOT THE VILLAGE MALL, SUITE 107
KINGSHILL VI
00851-0000
US

IV. Provider business mailing address

PO BOX 688
CHRISTIANSTED VI
00821-0688
US

V. Phone/Fax

Practice location:
  • Phone: 340-692-2600
  • Fax:
Mailing address:
  • Phone: 340-626-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6841
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number08-026 PSY
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: