Individual
JENNA MARIE WILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
29520 CANVASBACK DR, EASTON, MD 21601-7124
(410) 822-5007
(410) 822-5569
Mailing address
29315 ERICKSON DR, EASTON, MD 21601-8651
(410) 690-8181
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
19537
MD
1041C0700X
Clinical Social Worker
Primary
19537
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
346646
TRICARE/MHN
MD
05
—
609500300
—
MD
05
—
609550002
—
MD
01
—
7840093
AETNA
MD
01
—
R968
CAREFIRST
MD
Enumeration date
08/30/2012
Last updated
04/01/2020
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