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General NPI Number Information
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NPI Number | 1710040084
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Entity Type | Individual
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Provider Name | MARY ANTOINETTE MALANOWSKI LCSW C
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 336 SOUTH MAIN STREET STE 1 A
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City | BEL AIR
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State | MD
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Zip | 21014
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Country | US
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Telephone | 410-893-0995
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Fax | 410-339-7169
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Provider Business Mailing Address
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Address Line | 6300 MAGDOLENA RD
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City | BALTO
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State | MD
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Zip | 21237
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Country | US
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Telephone | 410-866-2998
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 07393
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License Number State | MD
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