Individual
IVORY MARVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3902 LAUSANNE RD, RANDALLSTOWN, MD 21133-4512
(443) 431-9695
Mailing address
PO BOX 763, PRINCE FREDERICK, MD 20678-0763
(443) 295-8955
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
27872
MD
Other
Enumeration date
12/15/2021
Last updated
12/15/2021
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