Healthcare Provider Details

I. General information

NPI: 1770705097
Provider Name (Legal Business Name): CAROL ANNE STANGE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROL STANGE LLCSW-C

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11305 MARINA DR APT 41
BERLIN MD
21811-9221
US

IV. Provider business mailing address

11305 MARINA DR APT 41
BERLIN MD
21811-9221
US

V. Phone/Fax

Practice location:
  • Phone: 410-430-0727
  • Fax: 410-548-9056
Mailing address:
  • Phone: 410-430-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09827
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number09827
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: