| Peninsula Pediatric Psychiatry | |
|
12350 Jefferson Ave Suite 190 Newport News VA 23602-6951 | |
| (757) 881-9444 | |
| Not Available |
| Full Name | Peninsula Pediatric Psychiatry |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 12350 Jefferson Ave, Newport News, Virginia |
| Authorized Official Name and Position | Julie B Trice (PRESIDENT) |
| Authorized Official Contact | 7575936792 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peninsula Pediatric Psychiatry 12350 Jefferson Ave Suite 190 Newport News VA 23602-6951 Ph: (757) 881-9444 | Peninsula Pediatric Psychiatry 12350 Jefferson Ave Suite 190 Newport News VA 23602-6951 Ph: (757) 881-9444 |
| NPI Number | 1982776902 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 06/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982776902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 0101230611 (Virginia) | Primary |
| 1041C0700X | Social Worker - Clinical | 05092005 (Virginia) | Secondary |
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