Healthcare Provider Details

I. General information

NPI: 1518552132
Provider Name (Legal Business Name): JENNIFER OWUSU LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10203 BALTIMORE AVE APT 6403
COLLEGE PARK MD
20740-4243
US

IV. Provider business mailing address

10203 BALTIMORE AVE APT 6403
COLLEGE PARK MD
20740-4243
US

V. Phone/Fax

Practice location:
  • Phone: 917-412-8754
  • Fax:
Mailing address:
  • Phone: 917-412-8754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099726
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: