Provider Demographics
NPI:1881349306
Name:BAZIL, MAVLYN
Entity type:Individual
Prefix:MS
First Name:MAVLYN
Middle Name:
Last Name:BAZIL
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 1:6925 OAKLAND MILLS RD # 502
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4714
Mailing Address - Country:US
Mailing Address - Phone:443-840-7996
Mailing Address - Fax:
Practice Address - Street 1:9736 EARLY SPRING WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2054
Practice Address - Country:US
Practice Address - Phone:703-398-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28067104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty