Healthcare Provider Details

I. General information

NPI: 1427266774
Provider Name (Legal Business Name): SANDRA HAMILTON PAGAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 STATE ROUTE 108 OAKLAND CENTER
COLUMBIA MD
21045-1951
US

IV. Provider business mailing address

9030 STATE ROUTE 108 OAKLAND CENTER
COLUMBIA MD
21045-1951
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1901
  • Fax: 410-740-8237
Mailing address:
  • Phone: 410-740-1901
  • Fax: 410-740-8237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08784
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: