Provider Demographics
NPI:1942775259
Name:CARGILL, MARY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CARGILL
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 1:14106 VALLEYFIELD DR APT 4
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5788
Mailing Address - Country:US
Mailing Address - Phone:301-821-6765
Mailing Address - Fax:
Practice Address - Street 1:14106 VALLEYFIELD DR APT 4
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5788
Practice Address - Country:US
Practice Address - Phone:301-821-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD185381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical