Healthcare Provider Details

I. General information

NPI: 1588193437
Provider Name (Legal Business Name): HEATHER ANN SAND LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S CLINTON STREET MAILSTOP CT 05-13
BALTIMORE MD
21224
US

IV. Provider business mailing address

1501 S CLINTON STREET MAILSTOP CT 05-13
BALTIMORE MD
21224
US

V. Phone/Fax

Practice location:
  • Phone: 757-285-9933
  • Fax:
Mailing address:
  • Phone: 443-904-1734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22559
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008200
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: