MEDICARE: SHAKERIA MONAE' HALL-MCGRONAN 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	25314	MD

General Provider Information

NPI Number	:	1952936304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAKERIA MONAE' HALL-MCGRONAN LCSW-C

Provider Business Mailing Address
First Line	:	3640 BENSON AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21227-1005
Country	:	US
Telephone Number	:	205-792-5556
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 LYNX LN STE 285
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2483
Country	:	US
Telephone Number	:	617-379-0496
Fax Number	:

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

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	07/07/2020

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