Provider Demographics
NPI:1225144330
Name:MERVIS, MARTHA C (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:C
Last Name:MERVIS
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11002 VEIRS MILL RD
Mailing Address - Street 2:SUITE 707
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2574
Mailing Address - Country:US
Mailing Address - Phone:301-802-7247
Mailing Address - Fax:
Practice Address - Street 1:11002 VEIRS MILL RD
Practice Address - Street 2:SUITE 707
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-2574
Practice Address - Country:US
Practice Address - Phone:301-802-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08728104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD236488OtherKAISER
DCF029OtherBC/BS
DC0070OtherBCBS
MD121894OtherVALUE OPTIONS
MD90060100Medicaid
MD54077OtherUBH
MD7866352OtherAETNA
MD236488OtherKAISER
MD121894OtherVALUE OPTIONS