Healthcare Provider Details

I. General information

NPI: 1043905284
Provider Name (Legal Business Name): JENNY TAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 CHERRY LANE CT STE 208
LAUREL MD
20707-4946
US

IV. Provider business mailing address

5534 WATERLOO RD
COLUMBIA MD
21045-2624
US

V. Phone/Fax

Practice location:
  • Phone: 301-604-1458
  • Fax:
Mailing address:
  • Phone: 240-780-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: