Provider Demographics
NPI:1346459955
Name:HALL, MARY ELIZABETH (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:HALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2500 Q ST NW
Mailing Address - Street 2:324
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4373
Mailing Address - Country:US
Mailing Address - Phone:202-342-9287
Mailing Address - Fax:
Practice Address - Street 1:530 7TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2768
Practice Address - Country:US
Practice Address - Phone:202-543-4645
Practice Address - Fax:202-543-4645
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3030101041C0700X
MD103281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC11232845OtherCAQH ID #
DC5607001OtherBCBS ID #
DCPR53206340001OtherCIGNA ID #
DC490292Medicare ID - Type UnspecifiedID #