Provider Demographics
NPI:1982963211
Name:CASSELL, MARTIN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:CASSELL
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8865 GLEBE PARK DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7003
Mailing Address - Country:US
Mailing Address - Phone:410-822-4619
Mailing Address - Fax:410-822-0984
Practice Address - Street 1:8865 GLEBE PARK DR UNIT 1
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7069
Practice Address - Country:US
Practice Address - Phone:410-822-4619
Practice Address - Fax:410-822-0984
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12056OtherLICENSED CERTIFIED SOCIAL WORKER-CLINICAL
MD0531561 00Medicaid