Provider Demographics
NPI:1134804784
Name:O'CONNELL, JENNIFER (LCSW-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-2130
Mailing Address - Country:US
Mailing Address - Phone:516-455-1655
Mailing Address - Fax:
Practice Address - Street 1:7501 GREENWAY CENTER DR STE 600
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-6704
Practice Address - Country:US
Practice Address - Phone:301-579-3969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD224541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical