Healthcare Provider Details

I. General information

NPI: 1629989215
Provider Name (Legal Business Name): CELIA BOLTANSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HAMILL RD STE 110
BALTIMORE MD
21210-1847
US

IV. Provider business mailing address

3151 TILDEN DR
BALTIMORE MD
21211-2744
US

V. Phone/Fax

Practice location:
  • Phone: 443-241-2731
  • Fax:
Mailing address:
  • Phone: 202-288-9348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35055
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: