Provider Demographics
NPI:1063440931
Name:MARQUIS, JEANNE MARIE (PHD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:MARQUIS
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 1:11325 RANDOM HILLS RD STE 360
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0972
Mailing Address - Country:US
Mailing Address - Phone:703-691-1326
Mailing Address - Fax:703-691-3553
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:STE 507
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7173
Practice Address - Country:US
Practice Address - Phone:703-691-1326
Practice Address - Fax:703-691-3553
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
754304C34Medicare ID - Type Unspecified
R82813Medicare UPIN