Provider Demographics
NPI:1164550703
Name:WALEN, ANDREW MARK (MSSW, LGSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:WALEN
Suffix:
Gender:M
Credentials:MSSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RESERVOIR CIR
Mailing Address - Street 2:103
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6324
Mailing Address - Country:US
Mailing Address - Phone:443-602-6515
Mailing Address - Fax:
Practice Address - Street 1:8 RESERVOIR CIR
Practice Address - Street 2:103
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6324
Practice Address - Country:US
Practice Address - Phone:443-602-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12719104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker