Healthcare Provider Details

I. General information

NPI: 1811489750
Provider Name (Legal Business Name): JENNA M CALTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 CALHOUN PL STE 700
ROCKVILLE MD
20855-3702
US

IV. Provider business mailing address

7300 CALHOUN PL STE 700
ROCKVILLE MD
20855-3702
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-4389
  • Fax: 240-777-4470
Mailing address:
  • Phone: 240-777-4389
  • Fax: 240-777-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06030
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: