Provider Demographics
NPI:1669673893
Name:SOBER, JENNIFER H (LCPC, LCMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:SOBER
Suffix:
Gender:F
Credentials:LCPC, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GALLOWAY AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-4931
Mailing Address - Country:US
Mailing Address - Phone:410-804-9404
Mailing Address - Fax:
Practice Address - Street 1:24 N COURT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5152
Practice Address - Country:US
Practice Address - Phone:410-876-1994
Practice Address - Fax:410-848-9599
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1166101YP2500X
MDLCM121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1X76OtherBLUE CROSS BLUE SHIELD