Healthcare Provider Details

I. General information

NPI: 1144993825
Provider Name (Legal Business Name): SAMUEL BENJAMIN HOPKINS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD
BALTIMORE MD
21212-3610
US

IV. Provider business mailing address

7333 ARGONNE DR
MARRIOTTSVILLE MD
21104-1074
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 617-460-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number27360
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: