Healthcare Provider Details

I. General information

NPI: 1780471946
Provider Name (Legal Business Name): SYDNEY ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 FALLSWAY
BALTIMORE MD
21202-4800
US

IV. Provider business mailing address

3302 ELGIN AVE
BALTIMORE MD
21216-2618
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-5533
  • Fax:
Mailing address:
  • Phone: 443-629-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13268
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: