Provider Demographics
NPI:1295883809
Name:PETTIT, JANE ELIZABETH (LICSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELIZABETH
Last Name:PETTIT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 47TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4006
Mailing Address - Country:US
Mailing Address - Phone:202-237-9066
Mailing Address - Fax:202-237-7068
Practice Address - Street 1:3000 CONNECTICUT AVENUE NW
Practice Address - Street 2:SUITE 304
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2509
Practice Address - Country:US
Practice Address - Phone:202-234-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3031781041C0700X
MA1116211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC6972OtherBLUECROSS BLUESHIELD