Provider Demographics
NPI:1306084678
Name:NEIDECKER, DONNA (LCSW-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:NEIDECKER
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 1:2 PINETREE CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1646
Mailing Address - Country:US
Mailing Address - Phone:410-825-4041
Mailing Address - Fax:
Practice Address - Street 1:606 HAMMONDS LN
Practice Address - Street 2:SUITE U1-5
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-3301
Practice Address - Country:US
Practice Address - Phone:410-789-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical