Healthcare Provider Details

I. General information

NPI: 1508701376
Provider Name (Legal Business Name): ELLEN ANDERSON FITZMAURICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 BENFIELD RD STE 300
SEVERNA PARK MD
21146-2517
US

IV. Provider business mailing address

565 BENFIELD RD STE 300
SEVERNA PARK MD
21146-2517
US

V. Phone/Fax

Practice location:
  • Phone: 667-777-4935
  • Fax: 443-775-7733
Mailing address:
  • Phone: 667-777-4935
  • Fax: 443-775-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15321
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: