Provider Demographics
NPI:1336290196
Name:BARBER, JEANNETTE M (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:M
Last Name:BARBER
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 1:1701 EDMONDSON AVENUE #209
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:443-840-8110
Mailing Address - Fax:410-788-3067
Practice Address - Street 1:1701 EDMONDSON AVENUE #209
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:443-840-8110
Practice Address - Fax:410-788-3067
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11236OtherSTATE LICENSE
MD745904Medicaid