Healthcare Provider Details

I. General information

NPI: 1407304942
Provider Name (Legal Business Name): ELIZABETH ROUSH LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 MINSTREL WAY STE 120
COLUMBIA MD
21045-5329
US

IV. Provider business mailing address

300 E LOMBARD ST STE 1700
BALTIMORE MD
21202-3243
US

V. Phone/Fax

Practice location:
  • Phone: 240-938-9955
  • Fax:
Mailing address:
  • Phone: 667-210-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21955
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21955
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: