Provider Demographics
NPI:1043966609
Name:BIVENS, GAYLENA ADDIE (PHD, LMSW)
Entity Type:Individual
Prefix:
First Name:GAYLENA
Middle Name:ADDIE
Last Name:BIVENS
Suffix:
Gender:F
Credentials:PHD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5696 ROYAL MILE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2317
Mailing Address - Country:US
Mailing Address - Phone:410-251-6024
Mailing Address - Fax:
Practice Address - Street 1:6508 DEER POINTE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1668
Practice Address - Country:US
Practice Address - Phone:410-742-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG05522104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker