Provider Demographics
NPI:1336456789
Name:CALDWELL, MARY E (LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:CALDWELL
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 1:752 TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3908
Mailing Address - Country:US
Mailing Address - Phone:443-897-2554
Mailing Address - Fax:
Practice Address - Street 1:752 TRENTON AVE
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3908
Practice Address - Country:US
Practice Address - Phone:443-897-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD083621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical