Healthcare Provider Details

I. General information

NPI: 1558804534
Provider Name (Legal Business Name): JOSEPH HARGADON LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST 5TH FLOOR
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

701 W PRATT ST 5TH FLOOR
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-2564
  • Fax: 410-328-0096
Mailing address:
  • Phone: 410-328-2564
  • Fax: 410-328-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19939
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: