Individual provider Active NPI

Cynthia Lynn Jenkins, PH.D.

  • Clinical Psychologist
  • Petersburg, VA
National Provider Identifier
1356419295
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0810004117 Issued in VA
Practice address
561 High St
Petersburg, VA 23803-3859
Phone
(804) 760-8323
Fax
(508) 433-1871
NPI assigned
Nov 30, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0810004117 VA Primary

Addresses

Primary practice location

561 High St
Petersburg, VA 23803-3859

Mailing address

PO Box 2406
Petersburg, VA 23804-2406
Phone (804) 760-8323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090902000596 VA Practitioner - Clinical Psychologist 6406901057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Riverbend Integrative Therapy LLCGroup PAC ID 3375089535, 2 clinicians

Practice addresses (Care Compare)

561 High St
Petersburg, VA 23803-3859
Phone (804) 760-8232

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0810004117VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Riverbend Integrative Therapy LLC Clinical CurrentSince Apr 1, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1356419295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2406",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238042406",
            "telephone_number": "804-760-8323",
            "fax_number": "508-433-1871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "561 HIGH ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238033859",
            "telephone_number": "804-760-8323",
            "fax_number": "508-433-1871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "CYNTHIA",
        "middle_name": "LYNN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810004117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.