Provider Demographics
NPI:1326488487
Name:GURGANIOUS, JANE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:GURGANIOUS
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 1:1179 DOUBLE CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL COVE
Mailing Address - State:MD
Mailing Address - Zip Code:21226-2219
Mailing Address - Country:US
Mailing Address - Phone:410-569-9497
Mailing Address - Fax:410-569-0094
Practice Address - Street 1:8146 QUARTERFIELD RD
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2705
Practice Address - Country:US
Practice Address - Phone:410-263-0222
Practice Address - Fax:410-569-0094
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical