Provider Demographics
NPI:1659300184
Name:REDDING, JENNIFER (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REDDING
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4914
Mailing Address - Country:US
Mailing Address - Phone:410-366-1980
Mailing Address - Fax:411-366-8530
Practice Address - Street 1:44 E GORDON ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2916
Practice Address - Country:US
Practice Address - Phone:410-808-7623
Practice Address - Fax:410-838-8953
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD117721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT541-0074OtherCAREFIRST BCBS
MD278321OtherCOMPSYCH
MD399439OtherTRICARE
MD621656-02OtherCAREFIRST BCBS