Provider Demographics
NPI:1588770523
Name:LOVE, MIRIAM M (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:M
Last Name:LOVE
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 1:11041 DORSCH FARM RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6267
Mailing Address - Country:US
Mailing Address - Phone:410-992-1469
Mailing Address - Fax:441-038-1471
Practice Address - Street 1:7120 MINSTREL WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:443-325-1151
Practice Address - Fax:410-381-4711
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100611041C0700X
VA09040015031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPVPB108875OtherAPS PROV #
MD10061OtherMD PROFESSIONAL LICENSE
MD465267OtherMAMSI PROV #
MD279529OtherVALUE OPTIONS PROVIDER #
VA0904001503OtherPROFESSIONAL LICENSE
MDS0694OtherCIGNA PROV #