Healthcare Provider Details

I. General information

NPI: 1235628439
Provider Name (Legal Business Name): MAGYARITA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MONTGOMERY VILLAGE AVE STE 400
GAITHERSBURG MD
20879-3548
US

IV. Provider business mailing address

306 PATTERSON CT APT 5
TAKOMA PARK MD
20912-7700
US

V. Phone/Fax

Practice location:
  • Phone: 301-963-7222
  • Fax:
Mailing address:
  • Phone: 240-277-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9424
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: