Provider Demographics
NPI:1720156474
Name:REID, ORLIE W (LCSWC)
Entity type:Individual
Prefix:
First Name:ORLIE
Middle Name:W
Last Name:REID
Suffix:
Gender:M
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 FOREST DR S- 5
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1019
Mailing Address - Country:US
Mailing Address - Phone:410-263-1100
Mailing Address - Fax:410-263-1150
Practice Address - Street 1:1616 FOREST DR S- 5
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1019
Practice Address - Country:US
Practice Address - Phone:410-263-1100
Practice Address - Fax:410-263-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD009101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ406Medicare PIN