Provider Demographics
NPI:1871265892
Name:DEVORE, JENNA FAY (MSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:FAY
Last Name:DEVORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:FAY
Other - Last Name:BROCIOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:144 CHURCH STREET NW
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:571-261-7764
Mailing Address - Fax:
Practice Address - Street 1:144 CHURCH ST NW STE 205
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4550
Practice Address - Country:US
Practice Address - Phone:703-622-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060116291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical