Doctor Name: | MS. SANDRA L LAKE |
NPI Number: | 1023393386 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W.-C. |
License Number: | 12755 |
Business Practice Address: | 350 Montevue Ln Frederick, MD - 217028214 |
Business Phone Number: | 3016001755 |
Business Fax Number: | 3016003214 |
Mailing Address: | 350 Montevue Ln, FREDERICK |
State: | MD |
Postal Code: | 217028214 |
Phone Number: | 3016001755 |
Fax Number: | 3016003214 |
NPI Enumeration Date: | 10/19/2011 |
NPI Last Update Date: | 10/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 12755 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |