Healthcare Provider Details

I. General information

NPI: 1427788892
Provider Name (Legal Business Name): AARON RICHARD UDEY LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 LA SALLE RD BLDG SUITE212
TOWSON MD
21286-2001
US

IV. Provider business mailing address

8600 LA SALLE RD BLDG SUITE212
TOWSON MD
21286-2001
US

V. Phone/Fax

Practice location:
  • Phone: 866-925-4891
  • Fax:
Mailing address:
  • Phone: 866-925-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28766
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: