Provider Demographics
NPI:1720268642
Name:KRIEGER, ELLEN SIROTA (LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:SIROTA
Last Name:KRIEGER
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 FALLSTAFF RD
Mailing Address - Street 2:
Mailing Address - City:BALTO
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1725
Mailing Address - Country:US
Mailing Address - Phone:410-358-4247
Mailing Address - Fax:410-358-4247
Practice Address - Street 1:3412 FALLSTAFF RD
Practice Address - Street 2:
Practice Address - City:BALTO
Practice Address - State:MD
Practice Address - Zip Code:21215-1725
Practice Address - Country:US
Practice Address - Phone:410-358-4247
Practice Address - Fax:410-358-4247
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD073721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical