Provider Demographics
NPI:1811326531
Name:BORNEMANN, JENNIFER (LCSW-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BORNEMANN
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 1:810 MONROE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-7101
Mailing Address - Country:US
Mailing Address - Phone:917-225-4837
Mailing Address - Fax:
Practice Address - Street 1:810 MONROE ST APT 202
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-7101
Practice Address - Country:US
Practice Address - Phone:917-225-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD176971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical