Provider Demographics
NPI:1336852953
Name:SMITH, JENNA PEMBERTON (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:PEMBERTON
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:SUZANNE
Other - Last Name:PEMBERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2109 CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-7046
Mailing Address - Country:US
Mailing Address - Phone:615-948-0377
Mailing Address - Fax:
Practice Address - Street 1:2109 CREEK TRL
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-7046
Practice Address - Country:US
Practice Address - Phone:615-948-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000074221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical