Provider Demographics
NPI:1831100742
Name:HENDRICK, MARY JOSEPH (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOSEPH
Last Name:HENDRICK
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 1:361 LONG MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-3004
Mailing Address - Country:US
Mailing Address - Phone:410-544-9181
Mailing Address - Fax:
Practice Address - Street 1:361 LONG MEADOW WAY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-3004
Practice Address - Country:US
Practice Address - Phone:410-544-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical