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General NPI Number Information
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NPI Number | 1932423134
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Entity Type | Individual
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Provider Name | MARY VALERIE KLOSEK LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 10451 TWIN RIVERS RD
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City | COLUMBIA
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State | MD
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Zip | 21044-2388
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Country | US
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Telephone | 410-997-3557
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Fax | 410-964-1791
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Provider Business Mailing Address
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Address Line | 4623 FALLS RD
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City | BALTIMORE
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State | MD
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Zip | 21209-4914
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Country | US
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Telephone | 410-366-1980
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Fax | 410-366-8530
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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 | 13160
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License Number State | MD
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