Provider Demographics
NPI:1215006598
Name:KAUL-BLACK, MARY E (LCSW C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:KAUL-BLACK
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 1:314 FRANKLIN AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811
Mailing Address - Country:US
Mailing Address - Phone:410-973-2525
Mailing Address - Fax:410-973-2527
Practice Address - Street 1:314 FRANKLIN AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-973-2525
Practice Address - Fax:410-973-2527
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0006OtherCAREFIRST FEDERAL PIN DC
MD259147000OtherMAGELLAN GROUP
MD609550001Medicaid
2101170OtherUNITED HEALTH CARE MAMSI
MDLM49EAOtherCAREFIRST BCBS GROUP
R968OtherCARE1ST FEDERAL GROUP DC
100075562001OtherAMERICAN PSYCH SYSTEM
MD522156095OtherAETNA
MD522156095OtherUNITED BEHAVIORAL HEALTH
MD269292000OtherMAGELLAN PIN
517251OtherUHC MAMSI GROUP #
724333OtherNCPPO PIN
MD60956202OtherCAREFIRST BCBS PIN
MD742LMedicare ID - Type Unspecified
MD522156095OtherAETNA