Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 13838 | MD |
NPI | 1003049545 |
---|---|
Provider Name | Mr. Mark Stephen Simulis |
First Address | Salisbury, MD 21804-5007 |
Second Address | Cambridge, MD 21613-6405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2009 |
Last Update Date | 01/09/2009 |