Healthcare Provider Details

I. General information

NPI: 1053613315
Provider Name (Legal Business Name): ROBIN LYNN STEFAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 FRANKLIN SQUARE DR STE 104
BALTIMORE MD
21237-5334
US

IV. Provider business mailing address

23 ATHERTON RD
LUTHERVILLE MD
21093-5703
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7785
  • Fax:
Mailing address:
  • Phone: 443-834-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12073
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: