Provider Demographics
NPI:1578613972
Name:RALPH, ELAINE SCHEIDEMAN (MSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:SCHEIDEMAN
Last Name:RALPH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 FANTASY LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-3058
Mailing Address - Country:US
Mailing Address - Phone:410-643-0243
Mailing Address - Fax:410-643-1889
Practice Address - Street 1:205 FANTASY LN
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-3058
Practice Address - Country:US
Practice Address - Phone:410-643-0243
Practice Address - Fax:410-643-1889
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64503901OtherRENDERING NUMBER
MD302RMedicare ID - Type Unspecified