=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154946390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAIMAH DAVENPORT LCSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2020
-----------------------------------------------------
Last Update Date | 06/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3013 MONTEBELLO TER
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21214-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-564-7466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 VIRIDIAN RD
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21001-3933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-564-7466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 23724
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------