Healthcare Provider Details

I. General information

NPI: 1104551670
Provider Name (Legal Business Name): NYJAE A. PRIDE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST FL 4
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

2311 SIENA WAY
WOODSTOCK MD
21163-1241
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-0980
  • Fax: 410-706-0984
Mailing address:
  • Phone: 443-680-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28352
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: