Healthcare Provider Details

I. General information

NPI: 1194301465
Provider Name (Legal Business Name): BIBHIAM M MCKINNEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BIBHIAM M CABRAL LICSW

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9075 N LAUREL RD UNIT K
LAUREL MD
20723-1570
US

IV. Provider business mailing address

9408 GRANDHAVEN AVE
UPPER MARLBORO MD
20772-5248
US

V. Phone/Fax

Practice location:
  • Phone: 202-681-6761
  • Fax:
Mailing address:
  • Phone: 202-681-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLC200002651
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017441
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: