Healthcare Provider Details

I. General information

NPI: 1831448729
Provider Name (Legal Business Name): HAZEL J HUDSON-PARKER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 SANDWOOD RD
SPARROWS POINT MD
21219-2371
US

IV. Provider business mailing address

4615 SANDWOOD ROAD
SPARROWS POINT MD
21219
US

V. Phone/Fax

Practice location:
  • Phone: 443-570-3537
  • Fax:
Mailing address:
  • Phone: 443-242-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18250
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier336116100
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: