Provider Demographics
NPI:1538446786
Name:ESTREET, ANTHONY (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:ESTREET
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 1:3301 BELAIR RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1257
Mailing Address - Country:US
Mailing Address - Phone:443-873-7193
Mailing Address - Fax:410-630-7882
Practice Address - Street 1:3301 BELAIR RD STE 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1257
Practice Address - Country:US
Practice Address - Phone:443-873-7193
Practice Address - Fax:410-630-7882
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1657101YA0400X
MD158131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD104050201Medicaid