Provider Demographics
NPI:1619269289
Name:CADDEN, MARY S (MS, LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:S
Last Name:CADDEN
Suffix:
Gender:F
Credentials:MS, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10410 KENSINGTON PKWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2943
Mailing Address - Country:US
Mailing Address - Phone:240-753-2889
Mailing Address - Fax:
Practice Address - Street 1:10410 KENSINGTON PKWY
Practice Address - Street 2:SUITE 209
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2943
Practice Address - Country:US
Practice Address - Phone:240-753-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0504343 00Medicaid