Provider Demographics
NPI:1154610848
Name:CORREA-ELKINS, JENNIFER CHRISTINA (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHRISTINA
Last Name:CORREA-ELKINS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:217 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1213
Mailing Address - Country:US
Mailing Address - Phone:410-833-0581
Mailing Address - Fax:410-833-8604
Practice Address - Street 1:217 MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1213
Practice Address - Country:US
Practice Address - Phone:410-833-0580
Practice Address - Fax:410-833-8604
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD654033300Medicaid
MD000672794OtherOPTUM
0009892665OtherAETNA
2182811OtherCIGNA HEALTHSPRING
302000OtherKAISER
548306OtherMHN (HEALTHNET)
600710604OtherMAGELLAN
K876-0006OtherCIGNA
MDP01547398OtherRAILROAD MEDICARE
MD654033300Medicaid