Healthcare Provider Details

I. General information

NPI: 1154900736
Provider Name (Legal Business Name): KHADIJAH JANEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SOLOMONS ISLAND RD
EDGEWATER MD
21037-1102
US

IV. Provider business mailing address

7529 STANDISH PL STE 355
DERWOOD MD
20855-2733
US

V. Phone/Fax

Practice location:
  • Phone: 443-433-5900
  • Fax: 410-841-6045
Mailing address:
  • Phone: 301-444-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32723
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: