Provider Demographics
NPI:1598501272
Name:EDWARDS, JENNIFER ELLEN (PHD, MA, NCSP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELLEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD, MA, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9602 LAMBETH CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1927
Mailing Address - Country:US
Mailing Address - Phone:301-520-4583
Mailing Address - Fax:
Practice Address - Street 1:9602 LAMBETH CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1927
Practice Address - Country:US
Practice Address - Phone:301-520-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06553103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist