Provider Demographics
NPI:1720289028
Name:CANIPE, CARROLL STEWART (LCSW-C)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:STEWART
Last Name:CANIPE
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 1:3355 SAINT JOHNS LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2605
Mailing Address - Country:US
Mailing Address - Phone:410-480-2010
Mailing Address - Fax:
Practice Address - Street 1:8258 VETERANS HWY
Practice Address - Street 2:STE 13
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1564
Practice Address - Country:US
Practice Address - Phone:410-480-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD068981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQT-52OtherMD BLUE CROSS&BLUE SHIELD
MDQT-52OtherMD BLUE CROSS&BLUE SHIELD