Provider Demographics
NPI:1801048137
Name:BACKERT, MARLENE KING (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:KING
Last Name:BACKERT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:B. MARLENE
Other - Middle Name:KING
Other - Last Name:BACKERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:121 REMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PORT DEPOSIT
Mailing Address - State:MD
Mailing Address - Zip Code:21904-1135
Mailing Address - Country:US
Mailing Address - Phone:410-658-2360
Mailing Address - Fax:410-658-5798
Practice Address - Street 1:1930 TURKEY POINT RD
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-5452
Practice Address - Country:US
Practice Address - Phone:410-287-5235
Practice Address - Fax:410-287-2556
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2822101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional