Healthcare Provider Details

I. General information

NPI: 1134664519
Provider Name (Legal Business Name): DEBORAH ENYIDAH LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S FREDERICK AVE STE 211
GAITHERSBURG MD
20877-1282
US

IV. Provider business mailing address

120 SISTER PIERRE DR STE 403
TOWSON MD
21204-7536
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-6408
  • Fax: 443-279-0537
Mailing address:
  • Phone: 410-823-6408
  • Fax: 443-279-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19820
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: