Provider Demographics
NPI:1104523240
Name:SASS, SHOSHANA (LGPC)
Entity type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:SASS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3135
Mailing Address - Country:US
Mailing Address - Phone:410-831-0605
Mailing Address - Fax:
Practice Address - Street 1:3655 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3905
Practice Address - Country:US
Practice Address - Phone:410-630-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health