Healthcare Provider Details

I. General information

NPI: 1407478019
Provider Name (Legal Business Name): SHIRLEY A HERBERT LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BESTGATE RD
ANNAPOLIS MD
21401-2117
US

IV. Provider business mailing address

2710 SUMMERVIEW WAY APT 302
ANNAPOLIS MD
21401-7760
US

V. Phone/Fax

Practice location:
  • Phone: 443-906-3506
  • Fax:
Mailing address:
  • Phone: 410-533-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11270
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: