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General NPI Number Information
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NPI Number | 1649760661
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Entity Type | Individual
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Provider Name | DENYSE MICHELLE PHILLIP-BLUE LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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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 | 410-871-6831
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Fax |
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Provider Business Mailing Address
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Address Line | 4506 RUNNYMEADE RD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-6156
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Country | US
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Telephone | 443-929-1675
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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 | 07553
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License Number State | MD
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