Provider Demographics
NPI:1437334562
Name:BOLANDER, RANESA L (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:RANESA
Middle Name:L
Last Name:BOLANDER
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 1:3635 OLD COURT RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3915
Mailing Address - Country:US
Mailing Address - Phone:410-602-0102
Mailing Address - Fax:410-602-8492
Practice Address - Street 1:138 SHELLCOVE RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-3045
Practice Address - Country:US
Practice Address - Phone:443-889-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ6710001OtherBLUE CROSS/BLUE SHIELD
MD409235000Medicaid
MDJ6710001OtherBLUE CROSS/BLUE SHIELD