Healthcare Provider Details

I. General information

NPI: 1255063749
Provider Name (Legal Business Name): ZOE SMITH DEGRAZIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD
BALTIMORE MD
21212-3610
US

IV. Provider business mailing address

2025 EASTERN AVE
BALTIMORE MD
21231-3037
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 240-476-2267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28632
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: