Provider Demographics
NPI:1760492763
Name:MORAN, JEAN PHILLIPS (MSW LCSWC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:PHILLIPS
Last Name:MORAN
Suffix:
Gender:F
Credentials:MSW LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E JOPPA RD
Mailing Address - Street 2:STE L101
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-337-7072
Mailing Address - Fax:410-337-7073
Practice Address - Street 1:200 E JOPPA RD
Practice Address - Street 2:STE L101
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-337-7072
Practice Address - Fax:410-337-7073
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10531OtherSTATE LICENSE
448RMedicare ID - Type Unspecified