Provider Demographics
NPI:1730753955
Name:SEWELL, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SEWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 BURWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2252
Mailing Address - Country:US
Mailing Address - Phone:410-353-0541
Mailing Address - Fax:
Practice Address - Street 1:815 RITCHIE HWY STE 213
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4165
Practice Address - Country:US
Practice Address - Phone:667-777-4935
Practice Address - Fax:443-775-7733
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD232511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical