Provider Demographics
NPI:1518169614
Name:FASS, ALISON (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:FASS
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 1:109 BONNIE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4209
Mailing Address - Country:US
Mailing Address - Phone:410-821-9447
Mailing Address - Fax:410-825-2942
Practice Address - Street 1:521 E JOPPA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5419
Practice Address - Country:US
Practice Address - Phone:410-821-9447
Practice Address - Fax:410-825-2942
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD051431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05143OtherLICENSE CERTIFICATION
MD607RMedicare ID - Type Unspecified