Healthcare Provider Details

I. General information

NPI: 1992810121
Provider Name (Legal Business Name): JOSEPH ROBERT JAMES LCSW C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8422 BELLONA LN STE 207
TOWSON MD
21204-2057
US

IV. Provider business mailing address

8422 BELLONA LN STE 207
TOWSON MD
21204-2057
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-6925
  • Fax: 410-321-6895
Mailing address:
  • Phone: 410-825-6925
  • Fax: 410-321-6895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number02748
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: