Healthcare Provider Details

I. General information

NPI: 1588128847
Provider Name (Legal Business Name): DENISE HESSELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 YORK RD STE B12
BALTIMORE MD
21212-4245
US

IV. Provider business mailing address

706 BROOKWOOD RD APT 2
BALTIMORE MD
21229-1400
US

V. Phone/Fax

Practice location:
  • Phone: 410-532-2476
  • Fax:
Mailing address:
  • Phone: 443-687-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18038
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18038
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: