Provider Demographics
NPI:1528847316
Name:ROOFE, JENELL TEHAYRRA
Entity type:Individual
Prefix:
First Name:JENELL
Middle Name:TEHAYRRA
Last Name:ROOFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 LOGAN DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6371
Mailing Address - Country:US
Mailing Address - Phone:301-532-5623
Mailing Address - Fax:
Practice Address - Street 1:378 LOGAN DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6371
Practice Address - Country:US
Practice Address - Phone:301-532-5623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker