Provider Demographics
NPI:1104004647
Name:CHANNEL MARKER, INC
Entity Type:Organization
Organization Name:CHANNEL MARKER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-822-4619
Mailing Address - Street 1:8865 GLEBE PARK DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7003
Mailing Address - Country:US
Mailing Address - Phone:410-822-4619
Mailing Address - Fax:410-822-0984
Practice Address - Street 1:420 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2446
Practice Address - Country:US
Practice Address - Phone:410-228-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD588251602Medicaid