Healthcare Provider Details

I. General information

NPI: 1821675596
Provider Name (Legal Business Name): PATRINA ANDERSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 DEBORAH JEAN DR
ELKRIDGE MD
21075-1003
US

IV. Provider business mailing address

7001 JOHNNYCAKE RD STE 101
BALTIMORE MD
21244-2419
US

V. Phone/Fax

Practice location:
  • Phone: 301-388-5069
  • Fax:
Mailing address:
  • Phone: 866-968-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09892
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: