MEDICARE: ELANA ROSE DORFMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker	23428	MD

General Provider Information

NPI Number	:	1306318761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELANA ROSE DORFMAN

Provider Business Mailing Address
First Line	:	7374 PARK HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21208-5436
Country	:	US
Telephone Number	:	404-550-3353
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 RUTHERFORD ROAD
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244
Country	:	US
Telephone Number	:	443-780-1422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	12/26/2018

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