Healthcare Provider Details

I. General information

NPI: 1881292993
Provider Name (Legal Business Name): PATRICE JOYCE MUNFORD LMSW-MASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4128 HAYWARD AVE
BALTIMORE MD
21215-4340
US

IV. Provider business mailing address

4200 FORBES BLVD STE 104
LANHAM MD
20706-4872
US

V. Phone/Fax

Practice location:
  • Phone: 301-241-6317
  • Fax:
Mailing address:
  • Phone: 301-731-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19001
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: