Healthcare Provider Details

I. General information

NPI: 1073353652
Provider Name (Legal Business Name): AARON JOSHUA GLASE-STOCK LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 LIGHT ST
BALTIMORE MD
21230-3850
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY STE 209
COLUMBIA MD
21044-6278
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-8066
  • Fax:
Mailing address:
  • Phone: 410-740-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31531
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: