Healthcare Provider Details

I. General information

NPI: 1841349479
Provider Name (Legal Business Name): TED CMARADA LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 PARK AVE
FREDERICK MD
21701-4931
US

IV. Provider business mailing address

340 PARK AVE
FREDERICK MD
21701-4931
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-1683
  • Fax: 301-663-3792
Mailing address:
  • Phone: 301-663-1683
  • Fax: 301-663-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04816
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: