Provider Demographics
NPI:1053493031
Name:MIRIAM M. LOVE, LCSW-C, P.A.
Entity Type:Organization
Organization Name:MIRIAM M. LOVE, LCSW-C, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-404-3817
Mailing Address - Street 1:7120 MINSTREL WAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-404-3817
Mailing Address - Fax:410-381-4711
Practice Address - Street 1:7120 MINSTREL WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-404-3817
Practice Address - Fax:410-381-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100611041C0700X
VA09040015031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTAX ID NUMBER