Healthcare Provider Details

I. General information

NPI: 1184020372
Provider Name (Legal Business Name): CAROLINE NKECHI OGUINE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 WHITE AVE
BALTIMORE MD
21206-3413
US

IV. Provider business mailing address

3613 WHITE AVE
BALTIMORE MD
21206-3413
US

V. Phone/Fax

Practice location:
  • Phone: 443-803-6358
  • Fax:
Mailing address:
  • Phone: 443-803-6358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: