Healthcare Provider Details

I. General information

NPI: 1639723018
Provider Name (Legal Business Name): JENNIFER S GARCIA MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNNE SELLS BSW, MSW

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 WINDING WAY
WESTVILLE NJ
08093-2217
US

IV. Provider business mailing address

609 WINDING WAY
WESTVILLE NJ
08093-2217
US

V. Phone/Fax

Practice location:
  • Phone: 410-727-1046
  • Fax:
Mailing address:
  • Phone: 410-727-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06236000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: