Provider Demographics
NPI:1447236997
Name:POPPECK, MARY JO (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:POPPECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEMORIAL AVE
Mailing Address - Street 2:CARROLL HOSPITAL CENTER
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5726
Mailing Address - Country:US
Mailing Address - Phone:410-848-3000
Mailing Address - Fax:410-871-6325
Practice Address - Street 1:200 MEMORIAL AVE
Practice Address - Street 2:CARROLL HOSPITAL CENTER
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5726
Practice Address - Country:US
Practice Address - Phone:410-848-3000
Practice Address - Fax:410-871-6325
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08116104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK6686475Medicare ID - Type Unspecified