Active NPI
Marie Mastromatteo Liddick
- Clinical Social Worker
- Berlin, MD
National Provider Identifier
1295258176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 20602
- Practice address
- 9730 Healthway Dr
Berlin, MD 21811-1154 - Phone
- (410) 629-0164
- Fax
- (410) 629-0185
- NPI assigned
- Jul 21, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 20602 | MD | Primary |
Addresses
Primary practice location
9730 Healthway Dr
Berlin, MD 21811-1154
Mailing address
6040 Public Landing Rd
Snow Hill, MD 21863-2453
Phone (410) 632-1100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20602 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500595200000",
"number": "1295258176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6040 PUBLIC LANDING RD",
"city": "SNOW HILL",
"state": "MD",
"postal_code": "218632453",
"telephone_number": "410-632-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9730 HEALTHWAY DR",
"city": "BERLIN",
"state": "MD",
"postal_code": "218111154",
"telephone_number": "410-629-0164",
"fax_number": "410-629-0185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDDICK",
"first_name": "MARIE",
"middle_name": "MASTROMATTEO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-21",
"last_updated": "2017-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "20602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berlin, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.