Provider Demographics
NPI:1780759076
Name:AYERS, JEAN FRENKIL (PSY D, PA-C)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:FRENKIL
Last Name:AYERS
Suffix:
Gender:F
Credentials:PSY D, PA-C
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:E
Other - Last Name:FRENKIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D; PA-C
Mailing Address - Street 1:112 S CROSS ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1549
Mailing Address - Country:US
Mailing Address - Phone:443-282-0481
Mailing Address - Fax:
Practice Address - Street 1:112 S CROSS ST FL 2
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1549
Practice Address - Country:US
Practice Address - Phone:443-282-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02442103T00000X, 103TC0700X
PAOA002811363AM0700X
PAMA054657363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
32555OtherJOHNS HOPKINS EHP
6149230OtherUNITED BEHAVIORAL HEALTH
MD58050006OtherCARE FIRST BCBS
MD225324OtherCOMPSYCH
256459OtherMAMSI
MD58050006OtherCARE FIRST BCBS