Provider Demographics
NPI:1972587343
Name:ABERNATHY, JANE CLAIRE (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:CLAIRE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:MS
Other - First Name:J
Other - Middle Name:CLAIRE
Other - Last Name:ABERNATHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:606 HIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2724
Mailing Address - Country:US
Mailing Address - Phone:443-392-1328
Mailing Address - Fax:443-901-3876
Practice Address - Street 1:606 HIGHWOOD DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2724
Practice Address - Country:US
Practice Address - Phone:443-392-1328
Practice Address - Fax:443-901-3876
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDL23861438OtherSOLE PROPRIETOR TAX ID