Provider Demographics
NPI:1053734624
Name:SERENE, JENNIFER (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SERENE
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 1:2121 FOLKSTONE RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3312
Mailing Address - Country:US
Mailing Address - Phone:410-446-2295
Mailing Address - Fax:
Practice Address - Street 1:2121 FOLKSTONE RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3312
Practice Address - Country:US
Practice Address - Phone:410-446-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-01
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4109972257Medicaid