Healthcare Provider Details

I. General information

NPI: 1285620005
Provider Name (Legal Business Name): MARIE BYRD LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LIBERTY HEIGHTS AVE SUITE 306
BALTIMORE MD
21215-8019
US

IV. Provider business mailing address

29466 PINTAIL DR SUITE 9
EASTON MD
21601-9323
US

V. Phone/Fax

Practice location:
  • Phone: 410-462-3532
  • Fax: 410-462-3586
Mailing address:
  • Phone: 410-770-5140
  • Fax: 410-770-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07798
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: