Provider Demographics
NPI:1386742658
Name:MASON MILLER, CAROL ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANNE
Last Name:MASON MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1812 BALTIMORE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7146
Mailing Address - Country:US
Mailing Address - Phone:410-751-6176
Mailing Address - Fax:410-857-4176
Practice Address - Street 1:1812 BALTIMORE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7146
Practice Address - Country:US
Practice Address - Phone:410-751-6176
Practice Address - Fax:410-857-4176
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD048461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC032866YMedicare ID - Type UnspecifiedMEDICARE NUMBER