Healthcare Provider Details

I. General information

NPI: 1780202887
Provider Name (Legal Business Name): LINDA NWANYIEZE IDOWU LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7844 SUNHAVEN WAY
SEVERN MD
21144-1613
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
BALTIMORE MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 214-270-5784
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number24816
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: