Provider Demographics
NPI:1184958522
Name:CARROLL, JENNIFER LEIGH (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41900 FENWICK ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3814
Mailing Address - Country:US
Mailing Address - Phone:301-475-9660
Mailing Address - Fax:301-475-8810
Practice Address - Street 1:41900 FENWICK ST
Practice Address - Street 2:SUITE #1
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3814
Practice Address - Country:US
Practice Address - Phone:301-475-9660
Practice Address - Fax:301-475-8810
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD091801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical