Provider Demographics
NPI:1386922276
Name:MARTIN, ERICA MARGARET (MSW, LGSW, CMFSW, AD)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:MARGARET
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW, LGSW, CMFSW, AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3677 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4511
Mailing Address - Country:US
Mailing Address - Phone:443-610-2404
Mailing Address - Fax:
Practice Address - Street 1:3677 PARK AVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4511
Practice Address - Country:US
Practice Address - Phone:443-610-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG1198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD27-2003375OtherLLC