Healthcare Provider Details

I. General information

NPI: 1770322950
Provider Name (Legal Business Name): ANGELA JOAN MOYNA LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 CANTERBURY RD APT J
BEL AIR MD
21014-9013
US

IV. Provider business mailing address

296 CANTERBURY RD APT J
BEL AIR MD
21014-9013
US

V. Phone/Fax

Practice location:
  • Phone: 443-655-3428
  • Fax:
Mailing address:
  • Phone: 443-655-3428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10021
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: