Healthcare Provider Details

I. General information

NPI: 1942828082
Provider Name (Legal Business Name): SHONTEL GASKIN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 FOREST DR STE A
ANNAPOLIS MD
21401-4430
US

IV. Provider business mailing address

9808 SOUTHALL RD
RANDALLSTOWN MD
21133-2014
US

V. Phone/Fax

Practice location:
  • Phone: 443-465-1901
  • Fax:
Mailing address:
  • Phone: 443-465-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22638
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: