Provider Demographics
NPI:1508682519
Name:MARKER, SUSAN LESLIE (MA, CAS, NCSP, LBA,)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LESLIE
Last Name:MARKER
Suffix:
Gender:F
Credentials:MA, CAS, NCSP, LBA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 GREEN VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5226
Mailing Address - Country:US
Mailing Address - Phone:410-428-7972
Mailing Address - Fax:
Practice Address - Street 1:820 E 43RD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4906
Practice Address - Country:US
Practice Address - Phone:410-396-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-7837103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool