MEDICARE: DR. CYNTHIA ANTOINETTE JONES PH D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810001851	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207999	OTHER	VA	ANTHEM BC BS

General Provider Information

NPI Number	:	1457422958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA ANTOINETTE JONES PH D

Provider Business Mailing Address
First Line	:	2 CARDINAL PARK DR SE
Second Line	:	SUITE 104A
City	:	LEESBURG
State	:	VA
Zip	:	20175-4448
Country	:	US
Telephone Number	:	703-779-8700
Fax Number	:	703-779-9767

Provider Business Practice Location Address
First Line	:	2 CARDINAL PARK DR SE
Second Line	:	SUITE 104A
City	:	LEESBURG
State	:	VA
Zip	:	20175-4448
Country	:	US
Telephone Number	:	703-779-8700
Fax Number	:	703-779-9767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	05/25/2016

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