MEDICARE: ANDREW STANTON LCSWC PC

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
2	104100000X	Social Worker	08831	MD

General Provider Information

NPI Number	:	1568588895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW STANTON LCSWC PC

Provider Business Mailing Address
First Line	:	8850 COLUMBIA 100 PKWY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045
Country	:	US
Telephone Number	:	410-707-1267
Fax Number	:	443-546-4473

Provider Business Practice Location Address
First Line	:	8850 COLUMBIA 100 PKWY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045
Country	:	US
Telephone Number	:	410-707-1267
Fax Number	:	443-546-4473

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW K STANTON
Credential	:	LCSWC
Telephone Number	:	443-546-4476

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/30/2008

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