Doctor Name: | MRS. MARY MARGUERITE HERETH-MULLOY |
NPI Number: | 1245360346 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW-C |
License Number: | 06379 |
Business Practice Address: | 6655 Sykesville Rd Solomon D Sykesville, MD - 217847966 |
Business Phone Number: | 4109707220 |
Business Fax Number: | 4109707313 |
Mailing Address: | 2600 Florence Rd, WOODBINE |
State: | MD |
Postal Code: | 217977843 |
Phone Number: | 4104897994 |
Fax Number: | 4104962411 |
NPI Enumeration Date: | 03/07/2007 |
NPI Last Update Date: | 05/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 06379 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |