Healthcare Provider Details

I. General information

NPI: 1013831601
Provider Name (Legal Business Name): ANDREA LIVINGSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PARK AVE STE 103
BALTIMORE MD
21201-5637
US

IV. Provider business mailing address

1010 PARK AVE STE 103
BALTIMORE MD
21201-5637
US

V. Phone/Fax

Practice location:
  • Phone: 410-624-7121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31712
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW005123
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: