Provider Demographics
NPI:1902823412
Name:DURHAM, JOANNA RUTH (LCSW C)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:RUTH
Last Name:DURHAM
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 1:3691 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4783
Mailing Address - Country:US
Mailing Address - Phone:410-456-7022
Mailing Address - Fax:
Practice Address - Street 1:3691 PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4783
Practice Address - Country:US
Practice Address - Phone:410-456-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD099341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0022OtherBSDC
150NOtherMBMD
360218OtherMHN
331945OtherMHN
593795443OtherMAMS
223634OtherCOMP
252450OtherCOMP
61766403OtherBSMD
705BPSOtherBSMD
K452OtherBSDC
150N133GOtherMBMD
100033364OtherAPS
226106OtherKAIS
266715000OtherMAGE
2131895OtherMAMS
790298000OtherMAGE
150NOtherMBMD
223634OtherCOMP