Provider Demographics
NPI:1093352916
Name:WOOD, MALLORY A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:A
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3509
Mailing Address - Country:US
Mailing Address - Phone:202-681-5303
Mailing Address - Fax:
Practice Address - Street 1:4805 GARRISON BLVD FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5695
Practice Address - Country:US
Practice Address - Phone:443-869-2600
Practice Address - Fax:443-869-2139
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD255591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty