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General NPI Number Information
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NPI Number | 1477025765
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Entity Type | Individual
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Provider Name | SHERLEASE RENEE BAGBY-CANNADY LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 17 WARREN RD STE 25A
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City | PIKESVILLE
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State | MD
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Zip | 21208-5003
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Country | US
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Telephone | 410-701-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 17 WARREN RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-5334
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Country | US
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Telephone | 410-701-0770
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 23725
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License Number State | MD
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