Provider Demographics
NPI:1164804217
Name:CONNOR, JENNIFER ROSE (LCSW-C)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ROSE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:STUDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:111 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143
Mailing Address - Country:US
Mailing Address - Phone:617-284-5141
Mailing Address - Fax:
Practice Address - Street 1:200 WOOD HILL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8724
Practice Address - Country:US
Practice Address - Phone:301-838-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical