Healthcare Provider Details

I. General information

NPI: 1902292162
Provider Name (Legal Business Name): JACQUELYN CONNOR STEUERMAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 N CHARLES ST
BALTIMORE MD
21210-2024
US

IV. Provider business mailing address

5407 N CHARLES ST
BALTIMORE MD
21210-2024
US

V. Phone/Fax

Practice location:
  • Phone: 410-433-8861
  • Fax:
Mailing address:
  • Phone: 410-433-8861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06573
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number06573
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: