Healthcare Provider Details

I. General information

NPI: 1679943583
Provider Name (Legal Business Name): JEAN MCHALE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6934 AVIATION BLVD SUITE N
GLEN BURNIE MD
21061-2593
US

IV. Provider business mailing address

6934 AVIATION BLVD SUITE N
GLEN BURNIE MD
21061-2593
US

V. Phone/Fax

Practice location:
  • Phone: 410-689-7400
  • Fax:
Mailing address:
  • Phone: 410-689-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13382
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: