Healthcare Provider Details

I. General information

NPI: 1356755458
Provider Name (Legal Business Name): JENNIFER MANNING PLASSNIG LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10709 BIRMINGHAM WAY
WOODSTOCK MD
21163-1403
US

IV. Provider business mailing address

10709 BIRMINGHAM WAY
WOODSTOCK MD
21163-1403
US

V. Phone/Fax

Practice location:
  • Phone: 410-203-2411
  • Fax: 410-418-4665
Mailing address:
  • Phone: 410-203-2411
  • Fax: 410-418-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09411
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: