Provider Demographics
NPI:1558983049
Name:HA, ANTHONY (LMSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:HA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 ANTIETAM DR
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-4880
Mailing Address - Country:US
Mailing Address - Phone:240-310-9962
Mailing Address - Fax:877-793-1645
Practice Address - Street 1:1190 MOUNT AETNA RD STE 206
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6833
Practice Address - Country:US
Practice Address - Phone:240-310-9962
Practice Address - Fax:877-793-1645
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD28348104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program