Provider Demographics
NPI:1184151326
Name:MAGUIRE, MARY LOU
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7954 BALTIMORE ANNAPOLIS BLVD STE 2C
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8187
Mailing Address - Country:US
Mailing Address - Phone:410-487-6052
Mailing Address - Fax:
Practice Address - Street 1:7954 BALTIMORE ANNAPOLIS BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8187
Practice Address - Country:US
Practice Address - Phone:410-487-6052
Practice Address - Fax:410-487-6052
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
018241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical