Provider Demographics
NPI:1427392760
Name:PARK, JENNIFER ALANE (LCSW-C, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALANE
Last Name:PARK
Suffix:
Gender:F
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8724
Mailing Address - Country:US
Mailing Address - Phone:301-838-4200
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:2012-11-26
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500792441041C0700X
MD179431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12455520OtherCAQH