Healthcare Provider Details

I. General information

NPI: 1528398849
Provider Name (Legal Business Name): PARADISE PATTERSON LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PARADISE BURROUGHS

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WEBER ST
BALTIMORE MD
21230-4106
US

IV. Provider business mailing address

4300 WILLSHIRE AVE
BALTIMORE MD
21206-4214
US

V. Phone/Fax

Practice location:
  • Phone: 410-752-5525
  • Fax: 410-752-5531
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG14498
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: