Basic Information
| Provider Information | |||||||||
| NPI: | 1447877527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENNINGS | ||||||||
| FirstName: | SABRINA | ||||||||
| MiddleName: | KATE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8100 INNOVATION PARK DR | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039706464 | ||||||||
| FaxNumber: | 5714146941 | ||||||||
| Practice Location | |||||||||
| Address1: | 8100 INNOVATION PARK DR | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039706464 | ||||||||
| FaxNumber: | 5714146941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2020 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 0810006852 | VA | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103T00000X | 0810006852 | VA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.