Healthcare Provider Details

I. General information

NPI: 1023191418
Provider Name (Legal Business Name): CHERYL A DEPETRO MSW,LCSW-C, DAC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 NEWBURG AVE STE 100
CATONSVILLE MD
21228-5168
US

IV. Provider business mailing address

9 NEWBURG AVE STE 100
CATONSVILLE MD
21228-5168
US

V. Phone/Fax

Practice location:
  • Phone: 410-747-9743
  • Fax: 410-747-9910
Mailing address:
  • Phone: 410-747-9743
  • Fax: 410-747-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01507
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09177
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: