Provider Demographics
NPI:1437617362
Name:WEINTRAUB, JENNA (LGSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 4TH ST SW APT 701
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2357
Mailing Address - Country:US
Mailing Address - Phone:734-904-8768
Mailing Address - Fax:
Practice Address - Street 1:1638 R ST NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6451
Practice Address - Country:US
Practice Address - Phone:202-779-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500828151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical