Provider Demographics
NPI:1447315072
Name:STANDER, HEIDI ADRIAN (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ADRIAN
Last Name:STANDER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 BEDFORD AVENUE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-733-7333
Mailing Address - Fax:410-602-1776
Practice Address - Street 1:1343 BEDFORD AVENUE
Practice Address - Street 2:SUITE 211
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-733-7333
Practice Address - Fax:410-602-1776
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD036161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical