Provider Demographics
NPI:1285282418
Name:COLLENDER, JASON ROBERT (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:COLLENDER
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WEATHERBEE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7807
Mailing Address - Country:US
Mailing Address - Phone:410-960-5272
Mailing Address - Fax:
Practice Address - Street 1:1447 YORK RD STE 802
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6017
Practice Address - Country:US
Practice Address - Phone:410-823-3344
Practice Address - Fax:410-823-1214
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD099721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical