Healthcare Provider Details

I. General information

NPI: 1457193880
Provider Name (Legal Business Name): JEAN YAWN LCSW-C
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 YORK RD STE K
TIMONIUM MD
21093-5122
US

IV. Provider business mailing address

1700 UNION AVE BLDG 1
BALTIMORE MD
21211-1499
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-9079
  • Fax:
Mailing address:
  • Phone: 443-300-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28798
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: