Healthcare Provider Details

I. General information

NPI: 1598062994
Provider Name (Legal Business Name): JENNY ELIZABETH MARDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ELIZABETH MARDER LCSW

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 W AGAVE LN
GREEN VALLEY AZ
85622-3278
US

IV. Provider business mailing address

1622 W AGAVE LN
GREEN VALLEY AZ
85622-3278
US

V. Phone/Fax

Practice location:
  • Phone: 217-741-7665
  • Fax:
Mailing address:
  • Phone: 217-741-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.018905
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: