Provider Demographics
NPI:1861953093
Name:GREENSPUN, JENNIFER (LCSW-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GREENSPUN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 CARVEL BEACH RD
Mailing Address - Street 2:
Mailing Address - City:CARVEL BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:21226-1947
Mailing Address - Country:US
Mailing Address - Phone:410-999-7108
Mailing Address - Fax:
Practice Address - Street 1:1406 CRAIN HWY S STE 104
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4086
Practice Address - Country:US
Practice Address - Phone:410-766-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15046OtherMARYLAND BOARD OF SOCIAL WORKERS