Provider Demographics
NPI:1407044969
Name:BOYLE, MARYANN (LCSWC)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:BOYLE
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 1:2021 CHANEYVILLE RD
Mailing Address - Street 2:#102
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736
Mailing Address - Country:US
Mailing Address - Phone:410-286-0664
Mailing Address - Fax:410-286-2834
Practice Address - Street 1:137 MITCHELLS CHANCE RD
Practice Address - Street 2:#260
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037
Practice Address - Country:US
Practice Address - Phone:410-956-5300
Practice Address - Fax:410-956-5301
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123031041C0700X
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical