Healthcare Provider Details

I. General information

NPI: 1770447013
Provider Name (Legal Business Name): EDUCATION AND THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 BENFIELD BLVD. -STE H
MILLERSVILLE MD
21108
US

IV. Provider business mailing address

1110 BENFIELD BLVD. -STE H
MILLERSVILLE MD
21108
US

V. Phone/Fax

Practice location:
  • Phone: 410-215-1110
  • Fax: 410-987-4710
Mailing address:
  • Phone: 410-215-1110
  • Fax: 410-987-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JUDITH M SIPES
Title or Position: DIRECTOR
Credential: LCSW-C
Phone: 410-215-1110