Healthcare Provider Details

I. General information

NPI: 1235060856
Provider Name (Legal Business Name): NICOLE M MUELLER LMSW, MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIC MUELLER LMSW, MED

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 KIRK AVE
BALTIMORE MD
21218-4828
US

IV. Provider business mailing address

2644 KIRK AVE
BALTIMORE MD
21218-4828
US

V. Phone/Fax

Practice location:
  • Phone: 443-763-0089
  • Fax:
Mailing address:
  • Phone: 443-763-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34783
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: