MEDICARE: MRS. SANDY HANSBOROUGH 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	15913	MD

General Provider Information

NPI Number	:	1609164631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDY HANSBOROUGH LCSW-C

Provider Business Mailing Address
First Line	:	59 KATE WAGNER RD
Second Line	:	CARROLL PLAZA SHOPPING CENTER
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-6957
Country	:	US
Telephone Number	:	410-848-2500
Fax Number	:	410-876-3016

Provider Business Practice Location Address
First Line	:	250 ENGLAR RD STE 3
Second Line	:	CARROLL PLAZA SHOPPING CENTER
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-2927
Country	:	US
Telephone Number	:	410-615-3469
Fax Number	:	800-251-0179

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

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	11/11/2016

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