Healthcare Provider Details

I. General information

NPI: 1457678799
Provider Name (Legal Business Name): DANETTE A COLVIN MSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 ELMLEY AVE
BALTIMORE MD
21213-1950
US

IV. Provider business mailing address

3506 ELMLEY AVE
BALTIMORE MD
21213-1950
US

V. Phone/Fax

Practice location:
  • Phone: 410-276-8421
  • Fax:
Mailing address:
  • Phone: 410-276-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15477
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number15477
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15477
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: