Healthcare Provider Details

I. General information

NPI: 1720200751
Provider Name (Legal Business Name): ELLEN D. CARR MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 SHAKER DR SUITE 110
COLUMBIA MD
21046-1143
US

IV. Provider business mailing address

11812 BRIGHT PSGE
COLUMBIA MD
21044-4348
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-4900
  • Fax:
Mailing address:
  • Phone: 410-997-4900
  • Fax: 410-997-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01926
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: