Provider Demographics
NPI:1477025765
Name:BAGBY-CANNADY, SHERLEASE RENEE (LGSW)
Entity Type:Individual
Prefix:
First Name:SHERLEASE
Middle Name:RENEE
Last Name:BAGBY-CANNADY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:SHERLEASE
Other - Middle Name:RENEE
Other - Last Name:BAGBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5334
Mailing Address - Country:US
Mailing Address - Phone:410-701-0770
Mailing Address - Fax:
Practice Address - Street 1:17 WARREN RD STE 25A
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5003
Practice Address - Country:US
Practice Address - Phone:410-701-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23725104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker