Healthcare Provider Details

I. General information

NPI: 1528356680
Provider Name (Legal Business Name): LILLIAN MARIE DONNARD MSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 GLENWOOD AVE
BALTIMORE MD
21212-4230
US

IV. Provider business mailing address

516 GLENWOOD AVE
BALTIMORE MD
21212-4230
US

V. Phone/Fax

Practice location:
  • Phone: 410-323-9811
  • Fax: 410-323-5303
Mailing address:
  • Phone: 410-323-9811
  • Fax: 410-323-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07773
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: