Provider Demographics
NPI:1114107224
Name:DUDDERAR, JENNIFER ANDREWS (MS, LCPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANDREWS
Last Name:DUDDERAR
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 EXECUTIVE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1759
Mailing Address - Country:US
Mailing Address - Phone:410-744-8422
Mailing Address - Fax:
Practice Address - Street 1:5710 EXECUTIVE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1759
Practice Address - Country:US
Practice Address - Phone:410-744-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health