Provider Demographics
NPI:1730707613
Name:PANOWITZ, MARY LYNN (CSCAD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:PANOWITZ
Suffix:
Gender:F
Credentials:CSCAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 WOLF CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-2000
Mailing Address - Country:US
Mailing Address - Phone:410-274-4290
Mailing Address - Fax:
Practice Address - Street 1:1361 BRASS MILL RD STE A
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1213
Practice Address - Country:US
Practice Address - Phone:410-273-9700
Practice Address - Fax:410-273-9713
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1915101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)