Provider Demographics
NPI:1598062994
Name:MARDER, JENNY ELIZABETH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:ELIZABETH
Last Name:MARDER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:MARDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1622 W AGAVE LN
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85622-3278
Mailing Address - Country:US
Mailing Address - Phone:217-741-7665
Mailing Address - Fax:
Practice Address - Street 1:1622 W AGAVE LN
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85622-3278
Practice Address - Country:US
Practice Address - Phone:217-741-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
IL149.0189051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171W00000XOther Service ProvidersContractor