Provider Demographics
NPI:1982020640
Name:DACKMAN, TERRI (MSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:DACKMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3618
Mailing Address - Country:US
Mailing Address - Phone:410-313-1400
Mailing Address - Fax:410-233-1666
Practice Address - Street 1:3800 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3618
Practice Address - Country:US
Practice Address - Phone:410-313-1400
Practice Address - Fax:410-233-1666
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical