Jennifer Broaddus, LCSW-C
Individual provider Active NPI Clinical Social Worker · Marriottsville, MD
NPI 1982211991 · NPPES record last updated Sep 24, 2020
Key facts
- NPI
- 1982211991
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 0583C (MD)
- Practice address
- 11376 Barley Field Way
Marriottsville, MD 21104-1339 - Phone
- (443) 472-5791
- NPI assigned
- Sep 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0583C | MD | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0583C | MD | Yes |
Addresses
Primary practice location
11376 Barley Field Way
Marriottsville, MD 21104-1339
Mailing address
11376 Barley Field Way
Marriottsville, MD 21104-1339
Phone (443) 472-5791
Other providers in Marriottsville, MD
- Aubrey Berry
- Victor Joseph Blanchard
- Amanda Blevins
- Laura Boeckner
- Elizabeth S Bower
- Ashley Renee Brown
- Carolyn Burns
- Caring4U
- Michele Krauss Carroll
- Christina Castro
All providers in Marriottsville, MD · Clinical Social Worker in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.