Healthcare Provider Details

I. General information

NPI: 1649314469
Provider Name (Legal Business Name): SANDY L HUMPHREYS MSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDY ELDER

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16359 SUSSEX HWY
BRIDGEVILLE DE
19933-2966
US

IV. Provider business mailing address

513 DRUID HILL AVE
SALISBURY MD
21801-6803
US

V. Phone/Fax

Practice location:
  • Phone: 302-337-7990
  • Fax:
Mailing address:
  • Phone: 410-430-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31754
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: