Provider Demographics
NPI:1891943809
Name:GREENBERG, JENNIFER H (LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 TENNYSON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2359
Mailing Address - Country:US
Mailing Address - Phone:646-670-6578
Mailing Address - Fax:
Practice Address - Street 1:4405 E WEST HWY STE 506
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4586
Practice Address - Country:US
Practice Address - Phone:646-670-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053719001041C0700X
NY068577104100000X
DCLC500786871041C0700X
MD176381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker