Healthcare Provider Details

I. General information

NPI: 1013387984
Provider Name (Legal Business Name): JENNIFER CLANCY BIRTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2015
Last Update Date: 10/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4666 LEONARDTOWN RD
WALDORF MD
20601-3672
US

IV. Provider business mailing address

4666 LEONARDTOWN RD
WALDORF MD
20601-3672
US

V. Phone/Fax

Practice location:
  • Phone: 856-392-1646
  • Fax:
Mailing address:
  • Phone: 856-392-1646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN CLANCY
Title or Position: SOLE MEMBER/OWNER
Credential: M.A.
Phone: 856-392-1646