Healthcare Provider Details

I. General information

NPI: 1003453630
Provider Name (Legal Business Name): MAHTA LAGHAIE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N CHARLES ST RM D225
BALTIMORE MD
21204-6819
US

IV. Provider business mailing address

6501 N CHARLES ST RM D225
BALTIMORE MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-3000
  • Fax: 410-938-5131
Mailing address:
  • Phone: 410-938-3000
  • Fax: 410-938-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20967
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: