Provider Demographics
NPI:1518315753
Name:KNICK-NDLOVU, SIPHOSENKOSI (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SIPHOSENKOSI
Middle Name:
Last Name:KNICK-NDLOVU
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:SIPHOSENKOSI
Other - Middle Name:
Other - Last Name:NDLOVU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:23 SHIPPING PL
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4318
Mailing Address - Country:US
Mailing Address - Phone:410-282-5401
Mailing Address - Fax:410-282-5403
Practice Address - Street 1:23 SHIPPING PL
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222
Practice Address - Country:US
Practice Address - Phone:410-282-5401
Practice Address - Fax:410-282-5403
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker