Healthcare Provider Details

I. General information

NPI: 1154610848
Provider Name (Legal Business Name): JENNIFER CHRISTINA CORREA-ELKINS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 MAIN STREET SUITE B
REISTERSTOWN MD
21136-1213
US

IV. Provider business mailing address

217 MAIN ST SUITE B
REISTERSTOWN MD
21136-1213
US

V. Phone/Fax

Practice location:
  • Phone: 410-833-0580
  • Fax: 410-833-8604
Mailing address:
  • Phone: 410-833-0581
  • Fax: 410-833-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15821
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: