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General NPI Number Information
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NPI Number | 1528875572
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Entity Type | Individual
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Provider Name | NYSHEDAH WISE LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 2401 W BELVEDERE AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-5216
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Country | US
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Telephone | 410-601-4514
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Fax |
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Provider Business Mailing Address
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Address Line | 13 STEEPLEJACK CT
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5202
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Country | US
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Telephone | 410-440-7796
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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 | 20465
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License Number State | MD
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