Provider Demographics
NPI:1548237373
Name:CROCKETT, MARGARET SHIELDS (LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:SHIELDS
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:11235 OAK LEAF DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1328
Mailing Address - Country:US
Mailing Address - Phone:301-593-3100
Mailing Address - Fax:301-593-6648
Practice Address - Street 1:11235 OAK LEAF DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1328
Practice Address - Country:US
Practice Address - Phone:301-593-3100
Practice Address - Fax:301-593-6648
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD048881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
647058Medicare ID - Type Unspecified