Provider Demographics
NPI:1306497565
Name:EVANS, JENNELLE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JENNELLE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 CORSICA AVE
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2513
Mailing Address - Country:US
Mailing Address - Phone:302-365-5935
Mailing Address - Fax:
Practice Address - Street 1:667 CORSICA AVE
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2513
Practice Address - Country:US
Practice Address - Phone:516-581-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100013141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical