Provider Demographics
NPI:1013387984
Name:JENNIFER CLANCY BIRTH SERVICES, LLC
Entity Type:Organization
Organization Name:JENNIFER CLANCY BIRTH SERVICES, LLC
Other - Org Name:JENNIFER CLANCY BIRTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:856-392-1646
Mailing Address - Street 1:4666 LEONARDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3672
Mailing Address - Country:US
Mailing Address - Phone:856-392-1646
Mailing Address - Fax:
Practice Address - Street 1:4666 LEONARDTOWN RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3672
Practice Address - Country:US
Practice Address - Phone:856-392-1646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-04
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty