Provider Demographics
NPI:1851288732
Name:JENKINS, AUTUMN (LMSW)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 N JUDSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2507
Mailing Address - Country:US
Mailing Address - Phone:215-282-3004
Mailing Address - Fax:
Practice Address - Street 1:230 S BROAD ST STE 402
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4108
Practice Address - Country:US
Practice Address - Phone:215-282-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1429541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical