Healthcare Provider Details

I. General information

NPI: 1114244829
Provider Name (Legal Business Name): ANN-LOUISE HARDESTY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN LOUISE BOYCE LCSW-C

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 HARFORD ROAD SUITE 204 KILGALEN ASSOCIATES
FALLSTON MD
21047
US

IV. Provider business mailing address

1716 HARFORD ROAD SUITE 204
FALLSTON MD
21047
US

V. Phone/Fax

Practice location:
  • Phone: 410-877-7207
  • Fax: 410-877-7224
Mailing address:
  • Phone: 410-877-7207
  • Fax: 410-877-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13797
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: