Provider Demographics
NPI:1780966002
Name:JENKINS, PATRICIA ANN (PHD,)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13617 JACQUELINE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5468
Mailing Address - Country:US
Mailing Address - Phone:301-236-0636
Mailing Address - Fax:301-384-9419
Practice Address - Street 1:13617 JACQUELINE CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5468
Practice Address - Country:US
Practice Address - Phone:301-236-0636
Practice Address - Fax:301-384-9419
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01992103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist