| Rosemedwardslcsw-c, Llc | |
|
2360 W Joppa Rd Ste 229 Lutherville MD 21093-4664 | |
| (443) 900-7145 | |
| Not Available |
| Full Name | Rosemedwardslcsw-c, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2360 W Joppa Rd Ste 229, Lutherville, Maryland |
| Authorized Official Name and Position | Rose M Edwards (SOLE OWNER, SOLE MEMBER) |
| Authorized Official Contact | 4439007145 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rosemedwardslcsw-c, Llc 720 Hollen Rd Baltimore MD 21212-2718 Ph: (443) 900-7145 | Rosemedwardslcsw-c, Llc 2360 W Joppa Rd Ste 229 Lutherville MD 21093-4664 Ph: (443) 900-7145 |
| NPI Number | 1750993002 |
|---|---|
| Provider Enumeration Date | 08/18/2020 |
| Last Update Date | 08/18/2020 |
| Certification Date | 08/18/2020 |
| Medicare PECOS PAC ID | 6608289467 |
|---|---|
| Medicare Enrollment ID | O20210115001559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750993002 | NPI | - | NPPES |
| 11523570 | Other | MD | CAQH |
| 333369800 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Rose M Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548214661 PECOS PAC ID: 4789618513 Enrollment ID: I20050921000847 |
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