Provider Demographics
NPI:1891087193
Name:MURRY, ELAINE (LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:MURRY
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:RICHARDSON-DALZELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW, LCSW-C
Mailing Address - Street 1:8817 CREEKWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4613
Mailing Address - Country:US
Mailing Address - Phone:240-513-9001
Mailing Address - Fax:
Practice Address - Street 1:9015 WOODYARD RD STE 109
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4226
Practice Address - Country:US
Practice Address - Phone:240-513-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084036-011041C0700X
DCLC3033011041C0700X
MD206491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1881637619Medicare NSC