Provider Demographics
NPI:1962143701
Name:CORDELL, MARTIA (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:MARTIA
Middle Name:
Last Name:CORDELL
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 SHIELD CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4334
Mailing Address - Country:US
Mailing Address - Phone:757-879-4743
Mailing Address - Fax:
Practice Address - Street 1:7105 SHIELD CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4334
Practice Address - Country:US
Practice Address - Phone:757-879-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083356104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker