Provider Demographics
NPI:1801168059
Name:AGBORTOKO, MARIE N
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:N
Last Name:AGBORTOKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 SANGAMORE RD STE N100
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2558
Mailing Address - Country:US
Mailing Address - Phone:240-779-5516
Mailing Address - Fax:240-474-0242
Practice Address - Street 1:22 S MARKET ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5570
Practice Address - Country:US
Practice Address - Phone:410-552-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23734104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker