Provider Demographics
NPI:1497861256
Name:MICHELS, MARIANN ELIZABETH (DED MARYLAND LICENSE)
Entity Type:Individual
Prefix:DR
First Name:MARIANN
Middle Name:ELIZABETH
Last Name:MICHELS
Suffix:
Gender:F
Credentials:DED MARYLAND LICENSE
Other - Prefix:MS
Other - First Name:MARIANN
Other - Middle Name:ELIZABETH
Other - Last Name:MORABITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4485 OLD SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:HARWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20776-9486
Mailing Address - Country:US
Mailing Address - Phone:410-867-7246
Mailing Address - Fax:410-867-0767
Practice Address - Street 1:4485 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:HARWOOD
Practice Address - State:MD
Practice Address - Zip Code:20776-9486
Practice Address - Country:US
Practice Address - Phone:410-867-7246
Practice Address - Fax:410-867-0767
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
MD02418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
509QMedicare ID - Type Unspecified