Provider Demographics
NPI:1366639171
Name:ALEWINE, DARA ROSOFF (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:ROSOFF
Last Name:ALEWINE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 HOLIDAY CT
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7005
Mailing Address - Country:US
Mailing Address - Phone:443-994-7456
Mailing Address - Fax:
Practice Address - Street 1:132 HOLIDAY CT
Practice Address - Street 2:SUITE 208
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7005
Practice Address - Country:US
Practice Address - Phone:443-994-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD097981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522346181OtherTRICARE
MDQG59DOtherCAREFIRST BCBS