Provider Demographics
NPI:1124859418
Name:BOTROS, JENNIFER GEORGE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GEORGE
Last Name:BOTROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14102 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2114
Mailing Address - Country:US
Mailing Address - Phone:717-682-7726
Mailing Address - Fax:
Practice Address - Street 1:14102 PARKLAND DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-2114
Practice Address - Country:US
Practice Address - Phone:717-682-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health