Healthcare Provider Details

I. General information

NPI: 1104034644
Provider Name (Legal Business Name): ROBIN ANN AUSTRAGER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 KENT AVE
GWYNN OAK MD
21207-4827
US

IV. Provider business mailing address

3508 W GATE DR
ELLICOTT CITY MD
21042-4027
US

V. Phone/Fax

Practice location:
  • Phone: 240-498-6068
  • Fax:
Mailing address:
  • Phone: 410-465-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11606
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: