Healthcare Provider Details

I. General information

NPI: 1750175006
Provider Name (Legal Business Name): JENNIFER HERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLADENSBURG RD NE STE 101
WASHINGTON DC
20002-8971
US

IV. Provider business mailing address

12164 LINCOLN LAKE WAY APT 4103
FAIRFAX VA
22030-7778
US

V. Phone/Fax

Practice location:
  • Phone: 202-529-2972
  • Fax:
Mailing address:
  • Phone: 909-243-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200002632
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: