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General NPI Number Information
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NPI Number | 1619793866
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Entity Type | Individual
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Provider Name | SARA RACHEL MATEER DEROSA LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 550 N BROADWAY STE 305
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City | BALTIMORE
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State | MD
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Zip | 21205-2004
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Country | US
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Telephone | 443-287-5559
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | BALTIMORE
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-6423
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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 | 23111
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License Number State | MD
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