Healthcare Provider Details

I. General information

NPI: 1619543824
Provider Name (Legal Business Name): ANNA PFEIFFER NYCUM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

IV. Provider business mailing address

2203 WHITCOMB CIR APT F
PARKVILLE MD
21234-2387
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-1980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24505
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: