Healthcare Provider Details

I. General information

NPI: 1275740920
Provider Name (Legal Business Name): JAN SHIREY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SUMMIT AVE
KENSINGTON MD
20895-2422
US

IV. Provider business mailing address

2101 E JEFFERSON ST
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-2500
  • Fax: 301-897-2333
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03718
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: