Healthcare Provider Details

I. General information

NPI: 1356992986
Provider Name (Legal Business Name): JENIFER RENAE LANORE MSW, LCSW-C, PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 GARDEN RIDGE RD
CATONSVILLE MD
21228-2217
US

IV. Provider business mailing address

129 GARDEN RIDGE RD
CATONSVILLE MD
21228-2217
US

V. Phone/Fax

Practice location:
  • Phone: 443-465-0317
  • Fax:
Mailing address:
  • Phone: 443-465-0317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18309
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: