Provider Demographics
NPI:1891464491
Name:WHITEHEAD, JENNIFER WEIDNER (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WEIDNER
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E MARKET ST STE 165
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-4804
Mailing Address - Country:US
Mailing Address - Phone:267-428-1485
Mailing Address - Fax:
Practice Address - Street 1:770 E MARKET ST STE 165
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4804
Practice Address - Country:US
Practice Address - Phone:267-428-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0223051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty