Individual
DAVIDRA BAZEMORE-BLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW-C
Contact information
Practice address
3200 CRAIN HWY, SUITE 203, WALDORF, MD 20603-4841
(240) 435-4708
Mailing address
3261 OLD WASHINGTON RD STE 2020, WALDORF, MD 20602-3231
(202) 997-6060
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
589561800
—
MD
05
—
589561802
—
MD
05
—
589561803
—
MD
Enumeration date
06/04/2013
Last updated
01/29/2020
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