Provider Demographics
NPI:1265146781
Name:OVERFLOW THERAPY LLC
Entity type:Organization
Organization Name:OVERFLOW THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:CLARENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-815-0005
Mailing Address - Street 1:4001 BUCKEYSTOWN PIKE UNIT 912
Mailing Address - Street 2:
Mailing Address - City:BUCKEYSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21717-7545
Mailing Address - Country:US
Mailing Address - Phone:240-815-0005
Mailing Address - Fax:
Practice Address - Street 1:6521 WALCOTT LN APT 103
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-4816
Practice Address - Country:US
Practice Address - Phone:240-815-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty