Healthcare Provider Details

I. General information

NPI: 1497206239
Provider Name (Legal Business Name): MARINA PILAR NELLIUS LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARINA PILAR TOMPKINS LCSW

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD MED STAR TOTAL ELDER CARE
BALTIMORE MD
21239-2945
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD MED STAR TOTAL ELDER CARE
BALTIMORE MD
21239-2945
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-6100
  • Fax:
Mailing address:
  • Phone: 443-444-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13736
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: