MEDICARE: LUKE DEBOY LGSW, CAC-AD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	20144	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20144	OTHER	MD	SOCIAL WORKER

General Provider Information

NPI Number	:	1699285825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE DEBOY LGSW, CAC-AD

Provider Business Mailing Address
First Line	:	171A RYAN RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	171A RYAN RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4541
Country	:	US
Telephone Number	:	410-202-8951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	03/17/2018

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