Healthcare Provider Details

I. General information

NPI: 1467793596
Provider Name (Legal Business Name): MABEL MAGERS LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

IV. Provider business mailing address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-1980
  • Fax: 410-366-8530
Mailing address:
  • Phone: 410-366-1980
  • Fax: 410-366-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM374
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: