Provider Demographics
NPI:1396548848
Name:RIDENOUR, JOSHUA OWEN (LCSW-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:OWEN
Last Name:RIDENOUR
Suffix:
Gender:M
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 1:7428 E FURNACE BRANCH RD APT 2
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7353
Mailing Address - Country:US
Mailing Address - Phone:443-410-8208
Mailing Address - Fax:
Practice Address - Street 1:9841 BROKEN LAND PKWY STE 211
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3068
Practice Address - Country:US
Practice Address - Phone:443-708-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD289921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical