Healthcare Provider Details

I. General information

NPI: 1265125686
Provider Name (Legal Business Name): LUCRETIA SCOTT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 FITCH AVE STE 118
NOTTINGHAM MD
21236-3927
US

IV. Provider business mailing address

3708 SPRINGWOOD AVE
BALTIMORE MD
21206-2423
US

V. Phone/Fax

Practice location:
  • Phone: 410-870-2125
  • Fax:
Mailing address:
  • Phone: 443-224-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29769
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: