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NPI Code Detail

MEDICARE: JENNIFER MEJICANOS PAVON LGSW

MEDICARE: JENNIFER MEJICANOS PAVON LGSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLG200004441DC

General Provider Information

NPI Number : 1215885132
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MEJICANOS PAVON LGSW
Provider Business Mailing Address
First Line : 3424 TILDEN ST
Second Line :
City : BRENTWOOD
State : MD
Zip : 20722-1322
Country : US
Telephone Number : 202-344-6337
Fax Number :
Provider Business Practice Location Address
First Line : 2124 MARTIN LUTHER KING JR AVE SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-5732
Country : US
Telephone Number : 202-563-7632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/18/2026

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