Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810003739 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810003739 | VA |
NPI | 1003003427 |
---|---|
Provider Name | Jennifer Mcewan |
First Address | Alexandria, VA 22303-1448 |
Second Address | Alexandria, VA 22303-1448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2007 |
Last Update Date | 09/06/2021 |