Provider Demographics
NPI:1710040084
Name:MALANOWSKI, MARY ANTOINETTE (LCSW C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANTOINETTE
Last Name:MALANOWSKI
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ANTOINETTE
Other - Last Name:PALM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW C
Mailing Address - Street 1:6300 MAGDOLENA RD
Mailing Address - Street 2:
Mailing Address - City:BALTO
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:410-866-2998
Mailing Address - Fax:
Practice Address - Street 1:336 SOUTH MAIN STREET STE 1 A
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-893-0995
Practice Address - Fax:410-339-7169
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07393104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
6248839OtherUNITED BEHAVIORAL HEALTH
MD58050002OtherCARE FIRST BCBS
226037OtherCOM PSYCH
078344OtherVALUE OPTIONS
MD581M902FMedicare ID - Type Unspecified