Provider Demographics
NPI:1639636459
Name:UPHOFF, ERIN SAMANTHA
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:SAMANTHA
Last Name:UPHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3561
Mailing Address - Country:US
Mailing Address - Phone:410-652-5366
Mailing Address - Fax:
Practice Address - Street 1:2311 WILLOUGHBY BEACH RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3419
Practice Address - Country:US
Practice Address - Phone:410-612-1518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD221021041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22102OtherSOCIAL WORK LICENSE
MD519OtherMA BILLING