Healthcare Provider Details

I. General information

NPI: 1023882800
Provider Name (Legal Business Name): CAMERON ROSENTHAL JACKSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 YORK RD
TIMONIUM MD
21093-6016
US

IV. Provider business mailing address

1300 YORK RD BLDG A
TIMONIUM MD
21093-6016
US

V. Phone/Fax

Practice location:
  • Phone: 410-498-7624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27233
License Number StateMD

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: