Provider Demographics
NPI:1164639209
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 1:8865 GLEBE PARK DR
Practice Address - Street 2:UNIT 1
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7003
Practice Address - Country:US
Practice Address - Phone:410-822-4619
Practice Address - Fax:410-822-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X, 1041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3685021 00Medicaid
MD3685021 02Medicaid
MD269108Medicare PIN