Provider Demographics
NPI:1316583503
Name:UTERMAHLEN, JANUARY PAGE RAVEN (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:JANUARY
Middle Name:PAGE RAVEN
Last Name:UTERMAHLEN
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 JOHAHN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158
Mailing Address - Country:US
Mailing Address - Phone:410-259-3920
Mailing Address - Fax:
Practice Address - Street 1:5720 EXECUTIVE DR STE 100-105
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1757
Practice Address - Country:US
Practice Address - Phone:410-780-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD205591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical