Provider Demographics
NPI:1639630247
Name:MERRILL PLETTER, JENNIFER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MERRILL PLETTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2454
Mailing Address - Country:US
Mailing Address - Phone:202-425-3884
Mailing Address - Fax:
Practice Address - Street 1:751 ROCKVILLE PIKE UNIT 19B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1142
Practice Address - Country:US
Practice Address - Phone:301-339-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06059103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06059OtherBOARD OF EXAMINERS OF PSYCHOLOGISTS STATE OF MARYLAND
55972OtherNATIONAL REGISTER HEALTH SERVICE PSYCHOLOGIST