Healthcare Provider Details

I. General information

NPI: 1003729237
Provider Name (Legal Business Name): CRYSTAL ANITA MCFADDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 SANTA BARBARA RD UNIT 8574
ELKRIDGE MD
21075-7523
US

IV. Provider business mailing address

2015 EMMORTON RD STE 201
BEL AIR MD
21015-6180
US

V. Phone/Fax

Practice location:
  • Phone: 866-968-6342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34981
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: