MEDICARE: MR. MICHAEL J DENNIS LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	07605	MD

General Provider Information

NPI Number	:	1245900745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL J DENNIS LCSW-C

Provider Business Mailing Address
First Line	:	89 SWANTAMONT RD
Second Line	:
City	:	SWANTON
State	:	MD
Zip	:	21561-1031
Country	:	US
Telephone Number	:	301-616-1784
Fax Number	:

Provider Business Practice Location Address
First Line	:	89 SWANTAMONT RD
Second Line	:
City	:	SWANTON
State	:	MD
Zip	:	21561-1031
Country	:	US
Telephone Number	:	301-616-1784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	01/27/2022

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