Provider Demographics
NPI:1740536002
Name:GLASS SIEGEL, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:GLASS SIEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:GLASS-SIEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:3314 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5625
Mailing Address - Country:US
Mailing Address - Phone:443-257-9053
Mailing Address - Fax:410-764-6476
Practice Address - Street 1:3314 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-5625
Practice Address - Country:US
Practice Address - Phone:443-257-9053
Practice Address - Fax:410-764-6476
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD036611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical