Provider Demographics
NPI:1114131414
Name:GERBER, JODI ANDREA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ANDREA
Last Name:GERBER
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:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:LIBERTYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21762-0489
Mailing Address - Country:US
Mailing Address - Phone:301-695-4436
Mailing Address - Fax:301-695-9694
Practice Address - Street 1:65 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4371
Practice Address - Country:US
Practice Address - Phone:301-695-4436
Practice Address - Fax:301-695-9694
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD093841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD720BOtherBCBS MD PROVIDER ID
DCK4240001OtherBCBS NATIONAL CAP AREA