Healthcare Provider Details

I. General information

NPI: 1144347253
Provider Name (Legal Business Name): ANTHONIA CHINENYE OGBENNA LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 YORK RD
BALTIMORE MD
21212-2152
US

IV. Provider business mailing address

4238 OVERTON AVE
NOTTINGHAM MD
21236-4010
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-6696
  • Fax: 410-377-9687
Mailing address:
  • Phone: 410-663-0077
  • Fax: 410-377-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberG09390
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: