Provider Demographics
NPI:1770638785
Name:ZETTER, MARY LEE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:MARY LEE
Middle Name:
Last Name:ZETTER
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 1:610 HARBOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403
Mailing Address - Country:US
Mailing Address - Phone:410-268-8309
Mailing Address - Fax:410-268-7172
Practice Address - Street 1:610 HARBOR DRIVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403
Practice Address - Country:US
Practice Address - Phone:410-268-8309
Practice Address - Fax:410-268-7172
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD25341041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA0930001OtherBLUE CROSS BLUE SHEILD
MD215231200Medicaid
MD215231200Medicaid