Healthcare Provider Details

I. General information

NPI: 1972036911
Provider Name (Legal Business Name): PHILLIP LOVETT LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N CHARLES ST
BALTIMORE MD
21201-5505
US

IV. Provider business mailing address

1111 N CHARLES ST
BALTIMORE MD
21201-5505
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-2050
  • Fax: 866-629-0091
Mailing address:
  • Phone: 108-372-0504
  • Fax: 866-629-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18328
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: