Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003087115 |
---|---|
Provider Name | Jenna Lacey Newman |
First Address | Baltimore, MD 21209-1631 |
Second Address | Greenbelt, MD 20770-3523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2008 |
Last Update Date | 16/03/2015 |