Healthcare Provider Details

I. General information

NPI: 1336895184
Provider Name (Legal Business Name): TERESA CRENSHAW LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 KIRK AVE
BALTIMORE MD
21218-5507
US

IV. Provider business mailing address

8923 WALTHAM WOODS RD
PARKVILLE MD
21234-2447
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-8300
  • Fax: 410-383-3160
Mailing address:
  • Phone: 301-675-0964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50082464
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24562
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: