Provider Demographics
NPI:1063709079
Name:SAVAGE, SHEILA (CSC-AD TRAINEE)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:CSC-AD TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MASEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4852
Mailing Address - Country:US
Mailing Address - Phone:410-812-6429
Mailing Address - Fax:
Practice Address - Street 1:1931 GREENSPRING DR
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4113
Practice Address - Country:US
Practice Address - Phone:410-453-9553
Practice Address - Fax:410-453-9552
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDREF#306101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDREF#306OtherDHMH ALCOHOL & DRUG TRAINEE AUTHORIZATION