Individual
MRS. LORETTA CLARISE PETTIFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW,LICSW,LCSW-C,C.P
Contact information
Practice address
12611 HENRY DR SW, LAVALE, MD 21502-6147
(240) 727-2451
(301) 777-1951
Mailing address
12611 HENRY DR SW, LAVALE, MD 21502-6147
(240) 727-2451
(301) 777-1951
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
13717
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4172248 00
—
MD
Enumeration date
05/31/2007
Last updated
02/01/2019
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