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General NPI Number Information
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NPI Number | 1588900427
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Entity Type | Organization
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Legal Business Name | MARTA G CHANEY LLC
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Dates
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Enumeration Date | 12/21/2012
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Last Update Date | 12/21/2012
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Provider Practice Location Address
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Address Line | 3691 PARK AVE
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-4783
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Country | US
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Telephone | 410-707-5893
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 SUFFIELD CT
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City | COLUMBIA
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State | MD
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Zip | 21044-2772
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARTA GAY CHANEY
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Credential | LCSW-C
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Telephone | 410-707-5893
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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 | 05213
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License Number State | MD
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