Provider Demographics
NPI:1457793184
Name:RODRIGUEZ, LINDA VAN SCIVER (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:VAN SCIVER
Last Name:RODRIGUEZ
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 1:1202 MARYLAND AVE
Mailing Address - Street 2:MARYLAND PHYSICIAN HEALTH PROGRAM
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5512
Mailing Address - Country:US
Mailing Address - Phone:410-962-5580
Mailing Address - Fax:410-962-5583
Practice Address - Street 1:1202 MARYLAND AVE
Practice Address - Street 2:MARYLAND PHYSICIAN HEALTH PROGRAM
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5512
Practice Address - Country:US
Practice Address - Phone:410-962-5580
Practice Address - Fax:410-962-5583
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16140OtherMARYLAND BOARD OF SOCIAL WORK, LCSW-C