Provider Demographics
NPI:1821775966
Name:MARIAN HOUSE, INC.
Entity Type:Organization
Organization Name:MARIAN HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:DINEEN
Authorized Official - Last Name:ALLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-467-4121
Mailing Address - Street 1:949 GORSUCH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3602
Mailing Address - Country:US
Mailing Address - Phone:410-467-4121
Mailing Address - Fax:410-467-6709
Practice Address - Street 1:4105 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1237
Practice Address - Country:US
Practice Address - Phone:410-467-4161
Practice Address - Fax:410-467-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD448103800Medicaid