Provider Demographics
NPI:1659825966
Name:LOGAN, VERONICA S (LCSW-C)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:S
Last Name:LOGAN
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:PO BOX 26662
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-0462
Mailing Address - Country:US
Mailing Address - Phone:443-416-5667
Mailing Address - Fax:
Practice Address - Street 1:7 E FRANKLIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4792
Practice Address - Country:US
Practice Address - Phone:443-478-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD199261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical