Healthcare Provider Details

I. General information

NPI: 1649062746
Provider Name (Legal Business Name): LEAH MIETUS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N CHARLES ST STE 450B
BALTIMORE MD
21201-5318
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 202
GREENBELT MD
20770-3596
US

V. Phone/Fax

Practice location:
  • Phone: 240-965-0076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33142
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: