Provider Demographics
NPI:1013974526
Name:FALK, MARJORIE GAIL (LCSWC MA ADTR)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:GAIL
Last Name:FALK
Suffix:
Gender:F
Credentials:LCSWC MA ADTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E JOPPA ROAD #PH5
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-913-3565
Mailing Address - Fax:410-825-2979
Practice Address - Street 1:204 E JOPPA ROAD #PH5
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-913-3565
Practice Address - Fax:410-825-2979
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-03-24
Deactivation Date:2007-04-16
Deactivation Code:
Reactivation Date:2011-03-03
Provider Licenses
StateLicense IDTaxonomies
MD088721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
654RMedicare ID - Type Unspecified