Healthcare Provider Details

I. General information

NPI: 1073036224
Provider Name (Legal Business Name): SHELLEY SEARFOSS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S. CLINTON ST. MAILSTOP CT 05-13
BALTIMORE MD
21224
US

IV. Provider business mailing address

3128 EAST AVE
PARKVILLE MD
21234-3107
US

V. Phone/Fax

Practice location:
  • Phone: 410-953-1887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16123
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16123
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: