MEDICARE: WEATHERING CHANGES PSYCHOTHERAPY LLC

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1972115905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEATHERING CHANGES PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	24 N DECKER AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-1353
Country	:	US
Telephone Number	:	412-418-2504
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 INTERNATIONAL DR FL 23
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4737
Country	:	US
Telephone Number	:	410-635-1815
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MS. EMILY MARIE SWOVELAND
Credential	:	LCSW-C
Telephone Number	:	410-635-1815

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/20/2020

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