Provider Demographics
NPI:1831151844
Name:CHAY, DOUGLAS MARSHALL (MSW LCSW C)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MARSHALL
Last Name:CHAY
Suffix:
Gender:M
Credentials:MSW LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 B CRAIN HWY S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-760-5588
Mailing Address - Fax:410-760-9727
Practice Address - Street 1:1406B CRAIN HWY S
Practice Address - Street 2:SUITE 301
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4099
Practice Address - Country:US
Practice Address - Phone:410-760-5588
Practice Address - Fax:410-760-9727
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0008OtherBLUE SHIELD FEDERAL
10761882OtherCAQH
245079OtherMHN AND TRICARE
264800000OtherMAGELLAN BEHAVIORAL HEALT
287864OtherMAMSI UNITED HEALTH CARE
S003OtherBLUE SHIELD FEDERAL GROUP
162110OtherVALUE OPTIONS AND GREAT W
513264OtherNCPPO INNOVA MHIP
522229157OtherPHCS
7626281OtherAETNA BEHAVIORAL HEALTH
100033664OtherAPS
61002201OtherBLUE SHIELD OF MD