Provider Demographics
NPI:1740914449
Name:OLIN-FAHLE, MARKUS (LMSW)
Entity type:Individual
Prefix:MR
First Name:MARKUS
Middle Name:
Last Name:OLIN-FAHLE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 PENNYPOND LN N
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7260
Mailing Address - Country:US
Mailing Address - Phone:301-466-7759
Mailing Address - Fax:
Practice Address - Street 1:2002 MEDICAL PKWY STE 460
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3263
Practice Address - Country:US
Practice Address - Phone:443-590-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD266661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical