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General NPI Number Information
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NPI Number | 1174920235
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Entity Type | Individual
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Provider Name | MR. JEREMY PAUL DARDEN
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Gender | Male
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 02/13/2016
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Provider Practice Location Address
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Address Line | 2500 FAIT AVE
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City | BALTIMORE
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State | MD
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Zip | 21224-3719
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Country | US
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Telephone | 410-209-7275
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Fax |
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Provider Business Mailing Address
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Address Line | 8517 GREENS LN
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City | BALTIMORE
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State | MD
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Zip | 21244-1124
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Country | US
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Telephone | 410-209-7275
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14857
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License Number State | MD
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