Healthcare Provider Details

I. General information

NPI: 1467668913
Provider Name (Legal Business Name): TERRI D GUMM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 THOMAS JOHNSON DR STE 202L
FREDERICK MD
21702-4564
US

IV. Provider business mailing address

184 THOMAS JOHNSON DR STE 202L
FREDERICK MD
21702-4564
US

V. Phone/Fax

Practice location:
  • Phone: 240-644-7563
  • Fax:
Mailing address:
  • Phone: 301-733-0330
  • Fax: 301-733-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11423
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: