Healthcare Provider Details

I. General information

NPI: 1427489186
Provider Name (Legal Business Name): NINA HARRISON LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 TROUT RUN RD
CLINTON MD
20735-1568
US

IV. Provider business mailing address

5504 TROUT RUN RD
CLINTON MD
20735-1568
US

V. Phone/Fax

Practice location:
  • Phone: 202-423-4630
  • Fax:
Mailing address:
  • Phone: 202-423-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG50078138
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: