Provider Demographics
NPI:1962821884
Name:AVINGER, STEPHANIE D (LCSW-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:AVINGER
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 1:600 WYNDHURST AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2415
Mailing Address - Country:US
Mailing Address - Phone:267-235-4263
Mailing Address - Fax:443-279-2916
Practice Address - Street 1:600 WYNDHURST AVE STE 306
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2415
Practice Address - Country:US
Practice Address - Phone:267-235-4263
Practice Address - Fax:443-279-2916
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD196061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBK70-0000OtherCAREFIRST BCBS
MD079653100Medicaid