=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184360778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK HUFFMAN LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2022
-----------------------------------------------------
Last Update Date | 05/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 SOUTHFIELD PL
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21212-3816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-900-7850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 SOUTHFIELD PL
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21212-3816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-900-7850
-----------------------------------------------------
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 | 26524
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------