Healthcare Provider Details

I. General information

NPI: 1467066092
Provider Name (Legal Business Name): CIARA WIEGARD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NA NA NA LMSW

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 REISTERSTOWN RD
PIKESVILLE MD
21208-6320
US

IV. Provider business mailing address

1829 REISTERSTOWN RD SUITE 305
PIKESVILLE MD
21208
US

V. Phone/Fax

Practice location:
  • Phone: 443-449-5604
  • Fax:
Mailing address:
  • Phone: 410-302-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26262
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: