Provider Demographics
NPI:1508874397
Name:NED MANN, JACQUELYN (MSW)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:NED MANN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:NED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2 PLATEAU PL UNIT H
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3706
Mailing Address - Country:US
Mailing Address - Phone:443-676-1184
Mailing Address - Fax:
Practice Address - Street 1:6001 MONTROSE RD STE 102
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4872
Practice Address - Country:US
Practice Address - Phone:301-896-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNC-4381101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)