Provider Demographics
NPI:1033402078
Name:LAUDERBACK, E JEAN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:JEAN
Last Name:LAUDERBACK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7988 OLD GEORGETOWN RD
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2481
Mailing Address - Country:US
Mailing Address - Phone:301-718-4544
Mailing Address - Fax:301-718-4545
Practice Address - Street 1:7988 OLD GEORGETOWN RD
Practice Address - Street 2:SUITE 8A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2481
Practice Address - Country:US
Practice Address - Phone:301-718-4544
Practice Address - Fax:301-718-4545
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical