Basic Information
| Provider Information | |||||||||
| NPI: | 1639405012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAVAGE | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | LSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1407 YORK RD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | LUTHERVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210936097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108252281 | ||||||||
| FaxNumber: | 4108250757 | ||||||||
| Practice Location | |||||||||
| Address1: | 1407 YORK RD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | LUTHERVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210936097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108252281 | ||||||||
| FaxNumber: | 4108250757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2009 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | A05021 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | A05021 | 01 | MD | MARYLAND STATE BOARD OF SOCIAL WORK EXAMINERS | OTHER |