Healthcare Provider Details

I. General information

NPI: 1700287174
Provider Name (Legal Business Name): SARAH MILLER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH GRUM

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

1741 ASHLAND AVE
BALTIMORE MD
21205-1531
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-1842
  • Fax:
Mailing address:
  • Phone: 443-923-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: