Provider Demographics
NPI:1821675596
Name:ANDERSON, PATRINA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:PATRINA
Middle Name:
Last Name:ANDERSON
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 1:7001 JOHNNYCAKE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2419
Mailing Address - Country:US
Mailing Address - Phone:866-968-6342
Mailing Address - Fax:
Practice Address - Street 1:5920 DEBORAH JEAN DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-1003
Practice Address - Country:US
Practice Address - Phone:301-388-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD098921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical