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Individual

JOLIE GLASSMAN KERENICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
1900 N WEST ST, SUITE D, JACKSON, MS 39202-1033
(601) 709-1253
Mailing address
103 LINDEN CV, MADISON, MS 39110-4403
(601) 709-1253

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C5873
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
08138320
MS
Enumeration date
05/09/2007
Last updated
07/08/2007
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