Provider Demographics
NPI:1801344320
Name:BERNAL DE BAKER, JENNY MILENA (LMSW)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:MILENA
Last Name:BERNAL DE BAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2415
Mailing Address - Country:US
Mailing Address - Phone:703-297-5585
Mailing Address - Fax:
Practice Address - Street 1:9409 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2415
Practice Address - Country:US
Practice Address - Phone:703-297-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24680104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker