Provider Demographics
NPI:1952640658
Name:SERMONETA, JENNIFER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SERMONETA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 CARROLL AVE
Mailing Address - Street 2:SUITE 2 (UPSTAIRS)
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4465
Mailing Address - Country:US
Mailing Address - Phone:202-643-7536
Mailing Address - Fax:
Practice Address - Street 1:7040 CARROLL AVE
Practice Address - Street 2:SUITE 2 (UPSTAIRS)
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4465
Practice Address - Country:US
Practice Address - Phone:202-643-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05274103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical