Provider Demographics
NPI:1982761011
Name:ROSSWORK, SANDRA GOODY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:GOODY
Last Name:ROSSWORK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 HALSEY RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3221
Mailing Address - Country:US
Mailing Address - Phone:410-267-8739
Mailing Address - Fax:
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:SUITE207
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-315-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01051103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist