Provider Demographics
NPI:1073956181
Name:DROTLEFF, MARY NICHOLAS (MS LCMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NICHOLAS
Last Name:DROTLEFF
Suffix:
Gender:F
Credentials:MS LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 MEDALLION DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7333
Mailing Address - Country:US
Mailing Address - Phone:301-793-8528
Mailing Address - Fax:
Practice Address - Street 1:4403 MEDALLION DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7333
Practice Address - Country:US
Practice Address - Phone:301-793-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist