Provider Demographics
NPI:1104974336
Name:MARTIN, GAIL LOUISE (LCSW-C)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:LOUISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4118
Mailing Address - Country:US
Mailing Address - Phone:410-788-1790
Mailing Address - Fax:
Practice Address - Street 1:8028 RITCHIE HWY
Practice Address - Street 2:SUITE 310
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1075
Practice Address - Country:US
Practice Address - Phone:410-768-3361
Practice Address - Fax:410-768-3362
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD050661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical