Healthcare Provider Details

I. General information

NPI: 1891087193
Provider Name (Legal Business Name): ELAINE MURRY LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAINE RICHARDSON-DALZELL LICSW, LCSW-C

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 WOODYARD RD STE 109
CLINTON MD
20735-4226
US

IV. Provider business mailing address

8817 CREEKWAY DR
CLINTON MD
20735-4613
US

V. Phone/Fax

Practice location:
  • Phone: 240-513-9001
  • Fax:
Mailing address:
  • Phone: 240-513-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084036-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC303301
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20649
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: