Provider Demographics
NPI:1679554364
Name:OWEN, JEWEL VICTORIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEWEL
Middle Name:VICTORIA
Last Name:OWEN
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:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-0688
Mailing Address - Country:US
Mailing Address - Phone:340-626-9700
Mailing Address - Fax:
Practice Address - Street 1:113 BARREN SPOT
Practice Address - Street 2:THE VILLAGE MALL, SUITE 107
Practice Address - City:KINGSHILL
Practice Address - State:VI
Practice Address - Zip Code:00851-0000
Practice Address - Country:US
Practice Address - Phone:340-692-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6841103TC0700X
VI08-026 PSY103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767348500Medicaid
FLU2371XMedicare ID - Type UnspecifiedMANATEE COUNTY
FLU2371ZMedicare ID - Type UnspecifiedBROWARD COUNTY
FL767348500Medicaid
FLU2371YMedicare ID - Type UnspecifiedMIAMI-DADE COUNTY