Provider Demographics
NPI:1700263142
Name:SPADY, RAVEN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:SPADY
Suffix:
Gender:F
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 1:3 WALDEN CHERRY CT
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-3938
Mailing Address - Country:US
Mailing Address - Phone:443-691-6906
Mailing Address - Fax:
Practice Address - Street 1:3 WALDEN CHERRY CT
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-3938
Practice Address - Country:US
Practice Address - Phone:443-691-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health