Provider Demographics
NPI:1790129807
Name:JANKOWSKI, JOHN (LICSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:JANKOWSKI
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 12TH ST NE
Mailing Address - Street 2:SUITE #29234
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1144
Mailing Address - Country:US
Mailing Address - Phone:703-216-0544
Mailing Address - Fax:
Practice Address - Street 1:3401 12TH ST NE
Practice Address - Street 2:SUITE #29234
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1144
Practice Address - Country:US
Practice Address - Phone:703-216-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500796771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical