Healthcare Provider Details

I. General information

NPI: 1366306995
Provider Name (Legal Business Name): PATRICIA MONICA IVEY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1300 MERCANTILE LN STE 198
LARGO MD
20774-5339
US

IV. Provider business mailing address

3905 HAVARD ST
SILVER SPRING MD
20906-4312
US

V. Phone/Fax

Practice location:
  • Phone: 301-386-2991
  • Fax:
Mailing address:
  • Phone: 240-370-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15200
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: