Healthcare Provider Details

I. General information

NPI: 1619255437
Provider Name (Legal Business Name): ARDENA E REDDISH LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BALTIMORE ST
BALTIMORE MD
21223-1558
US

IV. Provider business mailing address

2000 W BALTIMORE ST
BALTIMORE MD
21223-1558
US

V. Phone/Fax

Practice location:
  • Phone: 410-362-3000
  • Fax:
Mailing address:
  • Phone: 410-362-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06555
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: