Healthcare Provider Details

I. General information

NPI: 1851734289
Provider Name (Legal Business Name): JOAN MARIE MCINERNEY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DISTILLERY RD STE 200
WESTMINSTER MD
21157-5344
US

IV. Provider business mailing address

10 DISTILLERY RD STE 200
WESTMINSTER MD
21157-5344
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-1478
  • Fax: 410-871-3219
Mailing address:
  • Phone: 410-871-1478
  • Fax: 410-857-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12090
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12090
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number12090
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12090
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: