MEDICARE: SENIOR CARE THERAPY LCSW OF MARYLAND LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	101YP2500X	Professional Counselor
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1912500463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR CARE THERAPY LCSW OF MARYLAND LLC

Provider Business Mailing Address
First Line	:	2719 HOLLYWOOD BLVD STE 5469
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4821
Country	:	US
Telephone Number	:	973-264-0023
Fax Number	:	973-264-0022

Provider Business Practice Location Address
First Line	:	822 GUILFORD AVE # 1526
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-3707
Country	:	US
Telephone Number	:	973-264-0023
Fax Number	:	973-264-0022

Authorized Official
Title or Position	:	LCSW
Name	:	ALISA ROSENFELD
Credential	:
Telephone Number	:	973-264-0023

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	01/26/2026

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