MEDICARE: MS. SHATIEA BLOUNT LCSW-C, LICSW

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	1041C0700X	Clinical Social Worker	LC50079306	DC
2	1041C0700X	Clinical Social Worker	15834	MD

General Provider Information

NPI Number	:	1811364920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHATIEA BLOUNT LCSW-C, LICSW

Provider Business Mailing Address
First Line	:	5557 BALTIMORE AVE STE 500-118
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1922
Country	:	US
Telephone Number	:	202-656-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	5557 BALTIMORE AVE STE 500-118
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1922
Country	:	US
Telephone Number	:	202-656-3064
Fax Number	:

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	01/31/2019

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