Provider Demographics
NPI:1467758367
Name:CRUICKSHANK, DONNA LYNN (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LYNN
Last Name:CRUICKSHANK
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 1:20320 SANDSFIELD TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4254
Mailing Address - Country:US
Mailing Address - Phone:240-483-2714
Mailing Address - Fax:
Practice Address - Street 1:20320 SANDSFIELD TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4254
Practice Address - Country:US
Practice Address - Phone:240-483-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD046281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD816700100Medicaid