Provider Demographics
NPI:1467469122
Name:MCLANEY, MARTHA J (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:J
Last Name:MCLANEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:MCLANEY
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:421 HIGH EARLS RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-3714
Mailing Address - Country:US
Mailing Address - Phone:410-404-7021
Mailing Address - Fax:
Practice Address - Street 1:421 HIGH EARLS RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-3714
Practice Address - Country:US
Practice Address - Phone:410-404-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD010281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6231560000Medicaid
MDPVPB123973OtherAPS HEALTHCARE
MD0004262280OtherAETNA
MD32551OtherJOHNS HOPKINS HC-EHP
MDQ019OtherCAREFIRST BC BS
MD6231560000Medicaid