Provider Demographics
NPI:1790385680
Name:GROBAN, JAMIE HANENBAUM (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:HANENBAUM
Last Name:GROBAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 E WEST HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4426
Mailing Address - Country:US
Mailing Address - Phone:301-960-4001
Mailing Address - Fax:301-970-4002
Practice Address - Street 1:4350 E WEST HWY STE 200
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4426
Practice Address - Country:US
Practice Address - Phone:301-960-4001
Practice Address - Fax:301-970-4002
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical