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General NPI Number Information
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NPI Number | 1396894044
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Entity Type | Individual
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Provider Name | ROGER MESSICK LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 711 W 40TH ST STE 323
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City | BALTIMORE
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State | MD
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Zip | 21211-2109
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Country | US
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Telephone | 410-366-1493
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Fax |
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Provider Business Mailing Address
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Address Line | 3716 BEECH AVE
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City | BALTIMORE
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State | MD
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Zip | 21211-2220
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Country | US
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Telephone | 410-366-1493
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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 | 09059
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License Number State | MD
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