Healthcare Provider Details

I. General information

NPI: 1932069051
Provider Name (Legal Business Name): BLAINE MUMAW LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26951 S TOURMALINE DR
HEBRON MD
21830-2171
US

IV. Provider business mailing address

26951 S TOURMALINE DR
HEBRON MD
21830-2171
US

V. Phone/Fax

Practice location:
  • Phone: 240-818-8459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21223
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: