Provider Demographics
NPI:1366101180
Name:ENGRUM, JAIME L (LMSW)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:ENGRUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18826 MCFARLIN DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1439
Mailing Address - Country:US
Mailing Address - Phone:240-426-8673
Mailing Address - Fax:
Practice Address - Street 1:18826 MCFARLIN DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1439
Practice Address - Country:US
Practice Address - Phone:240-426-8673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27524104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker