Basic Information
| Provider Information | |||||||||
| NPI: | 1164948006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOUDHARY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | BRIDGET | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11864 HART GLEN CT | ||||||||
| Address2: | |||||||||
| City: | NEW MARKET | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217747032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403441192 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8504 MAPLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BOONSBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217131817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017339067 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2017 | ||||||||
| LastUpdateDate: | 08/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.