Provider Demographics
NPI:1932582616
Name:AGBAJE, JENNA (LICSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:AGBAJE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:RODIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:3157 FARNAM ST
Mailing Address - Street 2:SUITE 7104 #7278
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131
Mailing Address - Country:US
Mailing Address - Phone:531-222-7861
Mailing Address - Fax:
Practice Address - Street 1:3157 FARNAM ST
Practice Address - Street 2:SUITE 7104 #7278
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131
Practice Address - Country:US
Practice Address - Phone:531-222-7861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1387, 1574, 45421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical