Provider Demographics
NPI:1184233405
Name:FOSTER, THERESA M (LMSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 MARLAU DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3216
Mailing Address - Country:US
Mailing Address - Phone:410-921-5932
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2945
Practice Address - Country:US
Practice Address - Phone:443-444-3848
Practice Address - Fax:443-444-3849
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09352104100000X
MDG090352104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker