Basic Information
| Provider Information | |||||||||
| NPI: | 1295811644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIEGLER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-C | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 973 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211580973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108485785 | ||||||||
| FaxNumber: | 4108485629 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 N COURT ST | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211575110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438218989 | ||||||||
| FaxNumber: | 8666642949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2006 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW016995 | PA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 04766 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 0455911 | 05 | MD | MEDICAID |