Healthcare Provider Details

I. General information

NPI: 1629934286
Provider Name (Legal Business Name): ALICIA LYNN STAVROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CLIPPER MILL RD
BALTIMORE MD
21211-1948
US

IV. Provider business mailing address

3600 CLIPPER MILL RD
BALTIMORE MD
21211-1948
US

V. Phone/Fax

Practice location:
  • Phone: 443-726-1318
  • Fax:
Mailing address:
  • Phone: 443-726-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33878
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: