Healthcare Provider Details

I. General information

NPI: 1447853346
Provider Name (Legal Business Name): REBECCA LYN SEADER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYN HAWLEY

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST STE 409
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

7754 MOONFALL CT
PASADENA MD
21122-2571
US

V. Phone/Fax

Practice location:
  • Phone: 443-449-5604
  • Fax:
Mailing address:
  • Phone: 443-564-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21164
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: