Healthcare Provider Details

I. General information

NPI: 1891115051
Provider Name (Legal Business Name): CARRIE DEEGAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WASHINGTON AVE
HALETHORPE MD
21227-3115
US

IV. Provider business mailing address

2700 WASHINGTON AVE
HALETHORPE MD
21227-3115
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-3984
  • Fax:
Mailing address:
  • Phone: 443-985-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: