Healthcare Provider Details

I. General information

NPI: 1851933113
Provider Name (Legal Business Name): JACQUELINE ZIRLIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6999 REISTERSTOWN RD STE 4
BALTIMORE MD
21215-1492
US

IV. Provider business mailing address

6999 REISTERSTOWN RD STE 4
BALTIMORE MD
21215-1492
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-3210
  • Fax:
Mailing address:
  • Phone: 667-600-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23167
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: