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General NPI Number Information
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NPI Number | 1245360346
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Entity Type | Individual
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Provider Name | MARY MARGUERITE HERETH-MULLOY LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 6655 SYKESVILLE RD SOLOMON D
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City | SYKESVILLE
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State | MD
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Zip | 21784-7966
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Country | US
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Telephone | 410-970-7220
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Fax | 410-970-7313
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Provider Business Mailing Address
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Address Line | 2600 FLORENCE RD
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City | WOODBINE
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State | MD
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Zip | 21797-7843
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Country | US
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Telephone | 410-489-7994
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Fax | 410-496-2411
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06379
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License Number State | MD
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