Provider Demographics
NPI:1659436343
Name:NEUSTADT, SALLY A (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:A
Last Name:NEUSTADT
Suffix:
Gender:F
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 1:127 W LEE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2420
Mailing Address - Country:US
Mailing Address - Phone:410-528-8895
Mailing Address - Fax:410-528-1995
Practice Address - Street 1:2360 W JOPPA RD
Practice Address - Street 2:SUITE 316
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4624
Practice Address - Country:US
Practice Address - Phone:410-337-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD34021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ304Medicare ID - Type Unspecified