Healthcare Provider Details

I. General information

NPI: 1407432495
Provider Name (Legal Business Name): NITIA SCOTT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 25TH ST
BALTIMORE MD
21218-5213
US

IV. Provider business mailing address

9649 BELAIR RD STE 104
NOTTINGHAM MD
21236-1117
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-0032
  • Fax:
Mailing address:
  • Phone: 410-529-1309
  • Fax: 410-529-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26909
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: