Provider Demographics
NPI:1780887489
Name:WYMAN, JEAN L (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:L
Last Name:WYMAN
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 1:6525 N CHARLES ST
Mailing Address - Street 2:GIBSON BUILDING OFFICE 132
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6872
Mailing Address - Country:US
Mailing Address - Phone:410-433-1583
Mailing Address - Fax:
Practice Address - Street 1:6525 N CHARLES ST
Practice Address - Street 2:GIBSON BUILDING OFFICE 132
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6872
Practice Address - Country:US
Practice Address - Phone:410-433-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical