Provider Demographics
NPI:1609889880
Name:MORITZ, JENNINE LOWE (PHD)
Entity type:Individual
Prefix:
First Name:JENNINE
Middle Name:LOWE
Last Name:MORITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9376 ATLEE STATION RD
Mailing Address - Street 2:HANOVER FAMILY PHYSICIANS PC
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116
Mailing Address - Country:US
Mailing Address - Phone:804-730-0990
Mailing Address - Fax:804-730-3375
Practice Address - Street 1:9376 ATLEE STATION RD
Practice Address - Street 2:HANOVER FAMILY PHYSICIANS PC
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-730-0990
Practice Address - Fax:804-730-3375
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810002077103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent