Jennifer Detter, LCSW-C
Individual provider
Active NPI
Social Worker · North East, MD
NPI 1922466150 · NPPES record last updated Feb 2, 2023
Key facts
- NPI
- 1922466150
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 24536 (MD)
- Practice address
- 71 Flint Dr
North East, MD 21901-3746
- Phone
- (443) 945-8754
- NPI assigned
- Feb 2, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20241202002883 |
MD |
Practitioner - Clinical Social Worker |
5698200590 |
Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 24536 | MD | MD | Neurology Physical Therapist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Social Worker |
104100000X |
24536 |
MD |
Yes |
Addresses
Primary practice location
71 Flint Dr
North East, MD 21901-3746
Mailing address
71 Flint Dr
North East, MD 21901-3746
Phone (443) 945-8754
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 24536 | Other | MD | MARYLAND BOARD OF SOCIAL WORK EXAMINERS |