Healthcare Provider Details

I. General information

NPI: 1679795868
Provider Name (Legal Business Name): ZINNER MEDIATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8288 TELEGRAPH RD SUITE A
ODENTON MD
21113-1130
US

IV. Provider business mailing address

8288 TELEGRAPH RD SUITE A
ODENTON MD
21113-1130
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-2237
  • Fax: 410-695-6038
Mailing address:
  • Phone: 410-672-2237
  • Fax: 410-695-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number02679
License Number StateMD

VIII. Authorized Official

Name: ROSLYN ZINNER
Title or Position: OWNER
Credential: LCSW-C
Phone: 410-672-2237