Provider Demographics
NPI:1710347919
Name:PORTEWIG, MARCELLA GERTRUDE (ACSW, LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:GERTRUDE
Last Name:PORTEWIG
Suffix:
Gender:F
Credentials:ACSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 STARBURN PATH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2570
Mailing Address - Country:US
Mailing Address - Phone:410-312-4982
Mailing Address - Fax:
Practice Address - Street 1:1106 UNIVERSITY BLVD W
Practice Address - Street 2:THE PATHWAYS SCHOOLS
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3302
Practice Address - Country:US
Practice Address - Phone:301-649-0778
Practice Address - Fax:301-649-2598
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD048531041S0200X
DCLC3005431041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool