Provider Demographics
NPI:1417516337
Name:PAUL, JENNIFER MENGEL (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MENGEL
Last Name:PAUL
Suffix:
Gender:
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:MENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3242 MANNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2270
Mailing Address - Country:US
Mailing Address - Phone:443-889-7883
Mailing Address - Fax:
Practice Address - Street 1:2505B COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:443-889-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0134631041C0700X
NCC0160931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical