Provider Demographics
NPI:1588840060
Name:WEST, JENNIFER MOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MOY
Last Name:WEST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11816 BROOKEVILLE LANDING CT
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4503
Mailing Address - Country:US
Mailing Address - Phone:301-390-4552
Mailing Address - Fax:301-390-4552
Practice Address - Street 1:8940 OLD ANNAPOLIS
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2129
Practice Address - Country:US
Practice Address - Phone:301-661-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02762103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool