Healthcare Provider Details

I. General information

NPI: 1366275265
Provider Name (Legal Business Name): CHRISTOPHER DAGENHART LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BUCKEYSTOWN PIKE STE 170
FREDERICK MD
21704-8380
US

IV. Provider business mailing address

5301 BUCKEYSTOWN PIKE STE 170
FREDERICK MD
21704-8380
US

V. Phone/Fax

Practice location:
  • Phone: 240-575-9688
  • Fax:
Mailing address:
  • Phone: 240-575-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32156
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: