Provider Demographics
NPI:1073193850
Name:MARSKI, JENNIFER MALLERY
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MALLERY
Last Name:MARSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 BLUE FOX WAY
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1860
Mailing Address - Country:US
Mailing Address - Phone:443-618-1051
Mailing Address - Fax:
Practice Address - Street 1:7939 HONEYGO BLVD STE 224
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5992
Practice Address - Country:US
Practice Address - Phone:410-933-3700
Practice Address - Fax:410-933-9200
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional