Healthcare Provider Details

I. General information

NPI: 1265337414
Provider Name (Legal Business Name): JENNA VILLALOBOS-OBLEDO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 EMMORTON RD STE 201
BEL AIR MD
21015-6180
US

IV. Provider business mailing address

27243 EQUESTRIAN DR
SALISBURY MD
21801-1837
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 336-214-5467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35111
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: