Provider Demographics
NPI:1265592398
Name:CHAPPELL, JEAN (LCSW-C)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:CHAPPELL
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 1:9006 WOODYARD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4206
Mailing Address - Country:US
Mailing Address - Phone:301-856-3636
Mailing Address - Fax:301-856-3633
Practice Address - Street 1:9006 WOODYARD RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4206
Practice Address - Country:US
Practice Address - Phone:301-856-3636
Practice Address - Fax:301-856-3633
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD021535B35Medicare PIN