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General NPI Number Information
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NPI Number | 1487933008
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Entity Type | Individual
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Provider Name | JENNIFER CLARE STUREK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2011
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Last Update Date | 08/13/2011
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Provider Practice Location Address
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Address Line | 887B RIO EAST CT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-8004
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Country | US
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Telephone | 434-220-4686
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Fax | 434-220-4687
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Provider Business Mailing Address
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Address Line | 887B RIO EAST CT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-8004
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Country | US
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Telephone | 434-220-4686
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Fax | 434-220-4687
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810-004453
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License Number State | VA
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