Provider Demographics
NPI:1447791280
Name:MEMBRENO, JORGE (LICSW)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:MEMBRENO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ADAMS ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1025
Mailing Address - Country:US
Mailing Address - Phone:703-623-3701
Mailing Address - Fax:
Practice Address - Street 1:25 ADAMS ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1025
Practice Address - Country:US
Practice Address - Phone:703-623-3701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500811431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical