Provider Demographics
NPI:1588602940
Name:DWORKIN, ANITA LAZIER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:LAZIER
Last Name:DWORKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10326 SIXPENCE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3807
Mailing Address - Country:US
Mailing Address - Phone:410-997-3961
Mailing Address - Fax:410-997-3999
Practice Address - Street 1:10326 SIXPENCE CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3807
Practice Address - Country:US
Practice Address - Phone:410-997-3961
Practice Address - Fax:410-997-3999
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD901103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD181L115BMedicare PIN