| Cedar Grove Psychological Services, Llc | |
|
405 E. Laburnum Avenue Ste 3, #373 Richmond VA 23222 | |
| (804) 821-0770 | |
| (804) 821-0790 |
| Full Name | Cedar Grove Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 405 E. Laburnum Avenue, Richmond, Virginia |
| Authorized Official Name and Position | Jennifer L. Matovich (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8048210770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar Grove Psychological Services, Llc 405 E. Laburnum Ave. Ste 3 #373 Richmond VA 23222 Ph: (804) 821-0770 | Cedar Grove Psychological Services, Llc 405 E. Laburnum Avenue Ste 3, #373 Richmond VA 23222 Ph: (804) 821-0770 |
| NPI Number | 1790518660 |
|---|---|
| Provider Enumeration Date | 08/24/2024 |
| Last Update Date | 08/24/2024 |
| Certification Date | 08/24/2024 |
| Medicare PECOS PAC ID | 9234664434 |
|---|---|
| Medicare Enrollment ID | O20241125003575 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790518660 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jennifer Matovich |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417395484 PECOS PAC ID: 6507099231 Enrollment ID: I20140505001747 |
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