Healthcare Provider Details

I. General information

NPI: 1982176624
Provider Name (Legal Business Name): MARYAM YASMIN ELBALGHITI-WILLIAMS LCSW-C, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 HARFORD RD # 142
BALTIMORE MD
21214-3261
US

IV. Provider business mailing address

4709 HARFORD RD # 142
BALTIMORE MD
21214-3261
US

V. Phone/Fax

Practice location:
  • Phone: 301-304-8020
  • Fax: 877-540-1237
Mailing address:
  • Phone: 301-304-8020
  • Fax: 877-540-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200001509
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013588
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21931
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: