Provider Demographics
NPI:1912576794
Name:LOLL, BARBARA (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:LOLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 HOUSLEY RD # 1030
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7030
Mailing Address - Country:US
Mailing Address - Phone:410-934-0372
Mailing Address - Fax:
Practice Address - Street 1:8 CARVEL CIR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1005
Practice Address - Country:US
Practice Address - Phone:109-340-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD274011041C0700X
OK66101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6610OtherBOARD OF LICENSED SOCIAL WORKERS