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NPI Code Detail

MEDICARE: MRS. PAULETTE THERESA HENDRICKS LCSW-C

MEDICARE: MRS. PAULETTE THERESA HENDRICKS 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
1101YM0800XMental Health Counselor06378MD
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1912246620
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PAULETTE THERESA HENDRICKS LCSW-C
Provider Business Mailing Address
First Line : 4216 WYNFIELD DR
Second Line :
City : OWINGS MILLS
State : MD
Zip : 21117-6171
Country : US
Telephone Number : 410-960-4760
Fax Number :
Provider Business Practice Location Address
First Line : 4000 BLACKBURN LN STE 150
Second Line :
City : BURTONSVILLE
State : MD
Zip : 20866-6127
Country : US
Telephone Number : 301-421-4241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2013
Last Update Date : 05/12/2021

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Directions to “ MRS. PAULETTE THERESA HENDRICKS LCSW-C” Practice Location

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