Provider Demographics
NPI:1588965198
Name:MACEWEN, IRMELA GRACE (MSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:IRMELA GRACE
Middle Name:
Last Name:MACEWEN
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:M
Other - Last Name:VENDEMIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW,LCSW-C
Mailing Address - Street 1:164 W MAIN ST STE A
Mailing Address - Street 2:P.O. BOX 277
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6279
Mailing Address - Country:US
Mailing Address - Phone:301-865-2226
Mailing Address - Fax:301-865-6720
Practice Address - Street 1:164 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6279
Practice Address - Country:US
Practice Address - Phone:301-865-2226
Practice Address - Fax:301-865-6720
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical