MEDICARE: JOSHUA OWEN RIDENOUR LCSW-C

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	1041C0700X	Clinical Social Worker	28992	MD

General Provider Information

NPI Number	:	1396548848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA OWEN RIDENOUR LCSW-C

Provider Business Mailing Address
First Line	:	7428 E FURNACE BRANCH RD APT 2
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21060-7353
Country	:	US
Telephone Number	:	443-410-8208
Fax Number	:

Provider Business Practice Location Address
First Line	:	9841 BROKEN LAND PKWY STE 211
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3068
Country	:	US
Telephone Number	:	443-708-5856
Fax Number	:

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

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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