Provider Demographics
NPI:1396018008
Name:CHUBB, MARY BETH (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:CHUBB
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:JUSTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:7070 SAMUEL MORSE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3424
Mailing Address - Country:US
Mailing Address - Phone:410-309-4600
Mailing Address - Fax:
Practice Address - Street 1:7070 SAMUEL MORSE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3424
Practice Address - Country:US
Practice Address - Phone:410-309-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical