Provider Demographics
NPI:1174172134
Name:CITRON, JAMIE DEBORAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:DEBORAH
Last Name:CITRON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18727 SILCOTT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3913
Mailing Address - Country:US
Mailing Address - Phone:781-724-9606
Mailing Address - Fax:
Practice Address - Street 1:18727 SILCOTT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3913
Practice Address - Country:US
Practice Address - Phone:781-724-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001482103T00000X
VA0810005134103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty