Provider Demographics
NPI:1639449853
Name:ANDERSON, CLIFFORD MEREDITH (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:MEREDITH
Last Name:ANDERSON
Suffix:
Gender:M
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 1:120 W SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5523
Mailing Address - Country:US
Mailing Address - Phone:410-916-3749
Mailing Address - Fax:
Practice Address - Street 1:130 W SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5523
Practice Address - Country:US
Practice Address - Phone:410-916-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD057951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical