Provider Demographics
NPI:1841447596
Name:ANTHONY, JENELLE ROBINSON (PSYD)
Entity type:Individual
Prefix:MRS
First Name:JENELLE
Middle Name:ROBINSON
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:JENELLE
Other - Middle Name:R
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2700 S VEITCH ST APT 407
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3064
Mailing Address - Country:US
Mailing Address - Phone:443-803-3336
Mailing Address - Fax:
Practice Address - Street 1:4141 W WILSON RD BLDG 1600
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-5162
Practice Address - Country:US
Practice Address - Phone:301-744-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MD04842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist