Provider Demographics
NPI:1710414958
Name:TRUMBULE, MARY PATRICIA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:TRUMBULE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22221 WESTERNPORT RD SW
Mailing Address - Street 2:
Mailing Address - City:WESTERNPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21562-2206
Mailing Address - Country:US
Mailing Address - Phone:240-774-0204
Mailing Address - Fax:301-533-3299
Practice Address - Street 1:22221 WESTERNPORT RD SW
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562-2206
Practice Address - Country:US
Practice Address - Phone:240-774-0204
Practice Address - Fax:301-533-3299
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD223091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical