Healthcare Provider Details

I. General information

NPI: 1376590414
Provider Name (Legal Business Name): JENNIFER MARIE MAXFIELD-DECARLO LCSW C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 GATEWAY DR STE 19C
BEL AIR MD
21014-4285
US

IV. Provider business mailing address

1208 E CHURCHVILLE RD STE 300
BEL AIR MD
21014-3485
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4600
  • Fax: 443-640-4358
Mailing address:
  • Phone: 410-826-5542
  • Fax: 443-640-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11153
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020401
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: