Healthcare Provider Details

I. General information

NPI: 1659032548
Provider Name (Legal Business Name): CHRISTINA HAZEL LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 W 7TH ST
FREDERICK MD
21702-4249
US

IV. Provider business mailing address

5453 FROGGY BOTTOM LN
FREDERICK MD
21703-7306
US

V. Phone/Fax

Practice location:
  • Phone: 240-415-8360
  • Fax:
Mailing address:
  • Phone: 301-473-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68294
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013965
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number69294
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28763
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: