Provider Demographics
NPI:1588900427
Name:MARTA G CHANEY LLC
Entity type:Organization
Organization Name:MARTA G CHANEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-707-5893
Mailing Address - Street 1:5501 SUFFIELD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3691 PARK AVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4783
Practice Address - Country:US
Practice Address - Phone:410-707-5893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K452OtherBSDC
PVPB117117OtherAPS
150NOtherMBMD
150N119GOtherMEDICARE UNSPECIFIED
0003OtherBSDC
150N119GOtherMBMD
253537OtherCOMP
226574OtherKAIS
331942OtherMHN
360218OtherMHN
54264604OtherBSMD
252450OtherCOMP
705BPSOtherBSMD
K452OtherBSDC