Healthcare Provider Details

I. General information

NPI: 1043690142
Provider Name (Legal Business Name): MARY WILLIAMS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 S CLINTON ST
BALTIMORE MD
21224-5007
US

IV. Provider business mailing address

1204 S CLINTON ST
BALTIMORE MD
21224-5007
US

V. Phone/Fax

Practice location:
  • Phone: 347-340-1790
  • Fax:
Mailing address:
  • Phone: 347-340-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25706
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: