Healthcare Provider Details

I. General information

NPI: 1174445795
Provider Name (Legal Business Name): PRINCESS JUDITH GRENLEAR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 CRAIN HWY
WALDORF MD
20601-2824
US

IV. Provider business mailing address

4750 COYLE RD APT 404
OWINGS MILLS MD
21117-5087
US

V. Phone/Fax

Practice location:
  • Phone: 240-585-5142
  • Fax:
Mailing address:
  • Phone: 443-845-5039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number30448
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: