Healthcare Provider Details

I. General information

NPI: 1124822903
Provider Name (Legal Business Name): CLAIRE PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205-1888
US

IV. Provider business mailing address

1741 ASHLAND AVE STE 642
BALTIMORE MD
21205-1531
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-2999
  • Fax:
Mailing address:
  • Phone: 443-923-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28723
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: