Provider Demographics
NPI:1679715619
Name:ADDISON, DENNIS JAMES (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:JAMES
Last Name:ADDISON
Suffix:
Gender:M
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 OLD COURT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5243
Mailing Address - Country:US
Mailing Address - Phone:410-496-2410
Mailing Address - Fax:410-496-2411
Practice Address - Street 1:5310 OLD COURT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5243
Practice Address - Country:US
Practice Address - Phone:410-496-2410
Practice Address - Fax:410-496-2411
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG093921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical