Provider Demographics
NPI:1962760793
Name:YAMADA, NATHAN (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:YAMADA
Suffix:
Gender:M
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 1:707 YORK RD
Mailing Address - Street 2:APT. 4107
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2546
Mailing Address - Country:US
Mailing Address - Phone:410-938-5209
Mailing Address - Fax:410-938-4461
Practice Address - Street 1:6501 N CHARLES ST
Practice Address - Street 2:RM A340
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-5209
Practice Address - Fax:410-938-4461
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD154011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical