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General NPI Number Information
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NPI Number | 1922322106
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Entity Type | Individual
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Provider Name | JENNIFER WRIGHT LCSW, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 3959 PENDER DR STE. 109
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City | FAIRFAX
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State | VA
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Zip | 22030-6041
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Country | US
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Telephone | 571-991-1490
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Fax |
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Provider Business Mailing Address
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Address Line | 3576 UNIVERSITY DR
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City | FAIRFAX
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State | VA
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Zip | 22030-2314
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007319
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14791
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License Number State | MD
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