Provider Demographics
NPI:1326088246
Name:CHANEY, MARTA GAY (LCSW C)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:GAY
Last Name:CHANEY
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 1:5501 SUFFIELD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2772
Mailing Address - Country:US
Mailing Address - Phone:410-707-5893
Mailing Address - Fax:
Practice Address - Street 1:3691 PARK AVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4783
Practice Address - Country:US
Practice Address - Phone:410-707-5893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
253537OtherCOMP
0003OtherBSDC
705BPSOtherBSMD
150NOtherMBMD
226574OtherKAIS
360218OtherMHN
150N119GOtherMBMD
252450OtherCOMP
54264604OtherBSMD
331942OtherMHN
K452OtherBSDC
PVPB117117OtherAPS
252450OtherCOMP
705BPSOtherBSMD