Healthcare Provider Details

I. General information

NPI: 1710807482
Provider Name (Legal Business Name): MOONLIGHT HEALTH PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 HARLEM AVE
BALTIMORE MD
21201-1407
US

IV. Provider business mailing address

7701 BELAIR RD
NOTTINGHAM MD
21236-4005
US

V. Phone/Fax

Practice location:
  • Phone: 443-514-8302
  • Fax:
Mailing address:
  • Phone: 443-514-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOVITA NWAUGWU
Title or Position: PROGRAM DIRECTOR
Credential: MSN AGPCNP-BC
Phone: 443-514-8302