Healthcare Provider Details

I. General information

NPI: 1568894012
Provider Name (Legal Business Name): JESSICA K WHITTEMORE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CHARLES ST SUITE 208
BALTIMORE MD
21201-5920
US

IV. Provider business mailing address

1800 N CHARLES ST SUITE 208
BALTIMORE MD
21201-5920
US

V. Phone/Fax

Practice location:
  • Phone: 410-234-2727
  • Fax: 410-234-2777
Mailing address:
  • Phone: 410-234-2727
  • Fax: 410-234-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15036
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: