Provider Demographics
NPI:1265023873
Name:SPANN, JOSHUA KALEAN (LICSW)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KALEAN
Last Name:SPANN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2460
Mailing Address - Country:US
Mailing Address - Phone:334-796-5469
Mailing Address - Fax:
Practice Address - Street 1:1628 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2460
Practice Address - Country:US
Practice Address - Phone:334-796-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500826601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical