Provider Demographics
NPI:1023435807
Name:ANDERSON, JEROME (DSW, LCSW, BCD, CCFC)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DSW, LCSW, BCD, CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22505 GATEWAY CENTER DR
Mailing Address - Street 2:PO BOX 1001
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-1001
Mailing Address - Country:US
Mailing Address - Phone:314-651-4014
Mailing Address - Fax:
Practice Address - Street 1:13106 CLARKSBURG SQUARE RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4514
Practice Address - Country:US
Practice Address - Phone:314-651-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110090281041C0700X
DCLC2000019491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical