Provider Demographics
NPI:1770705097
Name:STANGE, CAROL ANNE (LCSW-C)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:STANGE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:STANGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLCSW-C
Mailing Address - Street 1:11305 MARINA DR APT 41
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-9221
Mailing Address - Country:US
Mailing Address - Phone:410-430-0727
Mailing Address - Fax:
Practice Address - Street 1:11305 MARINA DR APT 41
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-9221
Practice Address - Country:US
Practice Address - Phone:410-430-0727
Practice Address - Fax:410-548-9056
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09827106H00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
241LMedicare ID - Type Unspecified