Provider Demographics
NPI:1912511791
Name:GOEBEL, JENNY (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:GOEBEL
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 1:300 N WASHINGTON ST STE 102G
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3441
Mailing Address - Country:US
Mailing Address - Phone:703-923-8965
Mailing Address - Fax:
Practice Address - Street 1:300 N WASHINGTON ST STE 102
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3441
Practice Address - Country:US
Practice Address - Phone:703-923-8965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040122881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical