Healthcare Provider Details

I. General information

NPI: 1568328623
Provider Name (Legal Business Name): CATHERINE MWANGI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 ARCADIA DR STE 100-125
FREDERICK MD
21703-7662
US

IV. Provider business mailing address

4714 ARCADIA DR STE 100-125
FREDERICK MD
21703-7662
US

V. Phone/Fax

Practice location:
  • Phone: 240-410-6006
  • Fax:
Mailing address:
  • Phone: 240-608-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1507923
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: