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General NPI Number Information
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NPI Number | 1770219255
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Entity Type | Individual
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Provider Name | MARSHA MATHIEU MA
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Gender | Female
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 7452 BALTIMORE ANNAPOLIS BLVD
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3547
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Country | US
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Telephone | 443-374-5044
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Fax |
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Provider Business Mailing Address
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Address Line | 30 SENECA ST
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2026
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Country | US
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Telephone | 718-877-5938
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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