Healthcare Provider Details

I. General information

NPI: 1538078613
Provider Name (Legal Business Name): NICOLAS MONTUFFAR LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 HOLABIRD AVE STE A
DUNDALK MD
21222-1788
US

IV. Provider business mailing address

1136 STEPHEN DR
MIDDLE RIVER MD
21220-4633
US

V. Phone/Fax

Practice location:
  • Phone: 410-656-2444
  • Fax:
Mailing address:
  • Phone: 410-656-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: