MEDICARE: MRS. SALLY A. NEUSTADT 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	3402	MD

General Provider Information

NPI Number	:	1659436343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY A. NEUSTADT LCSW-C

Provider Business Mailing Address
First Line	:	127 W LEE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-2420
Country	:	US
Telephone Number	:	410-528-8895
Fax Number	:	410-528-1995

Provider Business Practice Location Address
First Line	:	2360 W JOPPA RD
Second Line	:	SUITE 316
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-4624
Country	:	US
Telephone Number	:	410-337-5443
Fax Number	:

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

Provider Enumeration Date	:	12/25/2006
Last Update Date	:	07/08/2007

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