Healthcare Provider Details

I. General information

NPI: 1124182803
Provider Name (Legal Business Name): MARTA ELLEN ARCHER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5229 NEW DESIGN RD
FREDERICK MD
21703-7103
US

IV. Provider business mailing address

1182 CODORUS ST
FREDERICK MD
21702-1100
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-1320
  • Fax: 301-696-1390
Mailing address:
  • Phone: 301-682-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11790
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: