Healthcare Provider Details

I. General information

NPI: 1205133436
Provider Name (Legal Business Name): EMMA RIDGWAY M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19708 BODMER AVE
POOLESVILLE MD
20837-2248
US

IV. Provider business mailing address

19708 BODMER AVE
POOLESVILLE MD
20837-2248
US

V. Phone/Fax

Practice location:
  • Phone: 240-277-7866
  • Fax: 301-349-2856
Mailing address:
  • Phone: 240-277-7866
  • Fax: 301-349-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15950
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: