Provider Demographics
NPI:1063427722
Name:KITTREDGE, JOANNE STRADE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:STRADE
Last Name:KITTREDGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PRESTON AVENUE
Mailing Address - Street 2:STE 202F
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4491
Mailing Address - Country:US
Mailing Address - Phone:434-979-7755
Mailing Address - Fax:
Practice Address - Street 1:901 PRESTON AVENUE
Practice Address - Street 2:STE 202F
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4491
Practice Address - Country:US
Practice Address - Phone:434-979-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
084089OtherSOUTHERN HEALTH
091394OtherANTHEM BCBS
VA7758456Medicaid