Healthcare Provider Details

I. General information

NPI: 1275959025
Provider Name (Legal Business Name): NINA ANZALONE LCSW-C, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N BENTZ ST
FREDERICK MD
21701-4913
US

IV. Provider business mailing address

5 N BENTZ ST
FREDERICK MD
21701-4913
US

V. Phone/Fax

Practice location:
  • Phone: 301-631-2936
  • Fax: 301-631-2937
Mailing address:
  • Phone: 301-631-2936
  • Fax: 301-631-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03966
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: