Provider Demographics
NPI:1780187948
Name:STROOTMAN, CAROL MILLICENT
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MILLICENT
Last Name:STROOTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TALBOT ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3525
Mailing Address - Country:US
Mailing Address - Phone:410-822-1018
Mailing Address - Fax:
Practice Address - Street 1:300 TALBOT ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3525
Practice Address - Country:US
Practice Address - Phone:410-822-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD367255700Medicaid