Provider Demographics
NPI:1801644885
Name:SORENSEN, JENNA (LCSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3760
Mailing Address - Country:US
Mailing Address - Phone:952-484-6994
Mailing Address - Fax:
Practice Address - Street 1:12073 TECH RD STE B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7874
Practice Address - Country:US
Practice Address - Phone:301-593-1315
Practice Address - Fax:301-681-4699
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0228411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical