Provider Demographics
NPI:1477531812
Name:JERARDI, JEAN LITZEN (MSN, PMHCNS-BC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LITZEN
Last Name:JERARDI
Suffix:
Gender:F
Credentials:MSN, PMHCNS-BC
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:JEAN
Other - Last Name:LITZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10852 GREEN MOUNTAIN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2320
Mailing Address - Country:US
Mailing Address - Phone:410-730-3328
Mailing Address - Fax:
Practice Address - Street 1:10852 GREEN MOUNTAIN CIRCLE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2320
Practice Address - Country:US
Practice Address - Phone:410-730-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR069010364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403575500Medicaid
MD403575500Medicaid