Healthcare Provider Details

I. General information

NPI: 1003668427
Provider Name (Legal Business Name): MARIAM OLUWATOYINADUKE COKER LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 WARNER AVE
HYATTSVILLE MD
20784-2001
US

IV. Provider business mailing address

3908 WARNER AVE
HYATTSVILLE MD
20784-2001
US

V. Phone/Fax

Practice location:
  • Phone: 240-906-7724
  • Fax:
Mailing address:
  • Phone: 240-906-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200004113
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC200004113
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200002854
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: