Healthcare Provider Details

I. General information

NPI: 1962526772
Provider Name (Legal Business Name): SCOTT K. BIRDSONG LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8643 CHERRY LN
LAUREL MD
20707-6200
US

IV. Provider business mailing address

8643 CHERRY LN
LAUREL MD
20707-6200
US

V. Phone/Fax

Practice location:
  • Phone: 301-549-3602
  • Fax: 301-549-3605
Mailing address:
  • Phone: 301-549-3602
  • Fax: 301-549-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00498
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: