Healthcare Provider Details

I. General information

NPI: 1144730102
Provider Name (Legal Business Name): MICHAL BARNEFY CHUKRUN LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 OLD BRANCH AVE STE 212
CLINTON MD
20735-1642
US

IV. Provider business mailing address

12251 TILDENWOOD DR
ROCKVILLE MD
20852-4161
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-8516
  • Fax: 301-856-8515
Mailing address:
  • Phone: 240-461-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22117
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: