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General NPI Number Information
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NPI Number | 1053564062
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Entity Type | Individual
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Provider Name | MARY ELLEN MAENNER L.C.P.C.
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Gender | Female
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 10 GERARD AVE SUITE 210
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City | TIMONIUM
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State | MD
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Zip | 21093-3235
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Country | US
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Telephone | 410-252-1030
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Fax |
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Provider Business Mailing Address
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Address Line | 8359 HILLENDALE RD
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City | BALTIMORE
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State | MD
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Zip | 21234-5003
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Country | US
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Telephone | 443-794-0000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC2866
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License Number State | MD
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