Provider Demographics
NPI:1477011096
Name:NEDZBALA, ALLYSON (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:NEDZBALA
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 1:1200 S CONKLING ST APT 311
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5322
Mailing Address - Country:US
Mailing Address - Phone:301-254-3663
Mailing Address - Fax:
Practice Address - Street 1:4308 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3116
Practice Address - Country:US
Practice Address - Phone:667-205-1704
Practice Address - Fax:410-426-5650
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD220411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical