Provider Demographics
NPI:1467576447
Name:MARJORIE GAIL FALK,
Entity Type:Organization
Organization Name:MARJORIE GAIL FALK,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW -C, MA, ADTR
Authorized Official - Phone:410-913-3565
Mailing Address - Street 1:204 E JOPPA RD PH 5
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3118
Mailing Address - Country:US
Mailing Address - Phone:410-913-3565
Mailing Address - Fax:
Practice Address - Street 1:204 E JOPPA RD PH 5
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-3118
Practice Address - Country:US
Practice Address - Phone:410-913-3565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD088721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD654RMedicare ID - Type UnspecifiedMEDICARE NON-PAR #