Provider Demographics
NPI:1831939867
Name:MADISON, CLARISSA (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:SMIT6H
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2502 VINEYARD LN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1128
Mailing Address - Country:US
Mailing Address - Phone:301-659-4659
Mailing Address - Fax:
Practice Address - Street 1:2502 VINEYARD LN
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1128
Practice Address - Country:US
Practice Address - Phone:301-659-4659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200002862104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker