Provider Demographics
NPI:1215491527
Name:WYNN, ANASTASIA MARIE NEWBERRY (LCSW-C)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:MARIE NEWBERRY
Last Name:WYNN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:MARIE
Other - Last Name:NEWBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:PO BOX 2514
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-8514
Mailing Address - Country:US
Mailing Address - Phone:301-690-8404
Mailing Address - Fax:
Practice Address - Street 1:23140 MOAKLEY ST STE 6
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2931
Practice Address - Country:US
Practice Address - Phone:301-690-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW221341041C0700X
MD190381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical