Provider Demographics
NPI:1407617640
Name:JENKINS, ADJANI DIANA MONE (LSW)
Entity Type:Individual
Prefix:
First Name:ADJANI
Middle Name:DIANA MONE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 N JOHN RUSSELL CIR # B
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1019
Mailing Address - Country:US
Mailing Address - Phone:267-781-5328
Mailing Address - Fax:
Practice Address - Street 1:7116 CLINTON RD STE A
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5212
Practice Address - Country:US
Practice Address - Phone:856-629-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137131104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty