Bazemore-Blue, Davidra

Bazemore-Blue, Davidra is an individual health care provider with primary practice located at 3200 Crain Hwy Suite 203, Waldorf MD 20603-4841. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Bazemore-Blue, Davidra can be contacted via phone (240) 435-4708.

Contact Information

Primary practice address
3200 Crain Hwy Suite 203 Waldorf MD 20603-4841
Phone: (240) 435-4708
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X

Profile Details

NPI number 1124465802
LBN Legal business name Bazemore-Blue, Davidra
Credentials MSW, LCSW-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 4th, 2013
Last updated Jan 29th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124465802 NPPES
Maryland MEDICAID 589561803
Maryland MEDICAID 589561802
Maryland MEDICAID 589561800

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