Healthcare Provider Details

I. General information

NPI: 1912504549
Provider Name (Legal Business Name): ALLISON GRACE MARATTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22655 WASHINGTON ST STE 5
LEONARDTOWN MD
20650-3848
US

IV. Provider business mailing address

5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

V. Phone/Fax

Practice location:
  • Phone: 301-690-8008
  • Fax:
Mailing address:
  • Phone: 915-564-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115018
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21985
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: