Provider Demographics
NPI:1598967564
Name:CAMPENNI, JEAN STEWART
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:STEWART
Last Name:CAMPENNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:MARIE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:11704 HITCHING POST LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4406
Mailing Address - Country:US
Mailing Address - Phone:301-881-3475
Mailing Address - Fax:301-984-1273
Practice Address - Street 1:50 W MONTGOMERY AVE
Practice Address - Street 2:STE. 110
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4216
Practice Address - Country:US
Practice Address - Phone:301-251-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0957101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor