Healthcare Provider Details

I. General information

NPI: 1023510088
Provider Name (Legal Business Name): PATRICE ANN REUPPERT LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 S CAMP MEADE RD STE 4-5
LINTHICUM MD
21090-2766
US

IV. Provider business mailing address

518 S CAMP MEADE RD STE 4
LINTHICUM MD
21090-2766
US

V. Phone/Fax

Practice location:
  • Phone: 443-354-8903
  • Fax: 443-280-6638
Mailing address:
  • Phone: 443-354-8903
  • Fax: 443-280-6638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03100
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: