Healthcare Provider Details

I. General information

NPI: 1780175042
Provider Name (Legal Business Name): DYANNE DUNLAP LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5923 WESTERN RUN DR APT C
BALTIMORE MD
21209-4044
US

IV. Provider business mailing address

5923 WESTERN RUN DR APT C
BALTIMORE MD
21209-4044
US

V. Phone/Fax

Practice location:
  • Phone: 856-304-7870
  • Fax:
Mailing address:
  • Phone: 856-304-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG50082947
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23209
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: