Healthcare Provider Details

I. General information

NPI: 1235846940
Provider Name (Legal Business Name): MARILYN NYALIMA KASSAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12106 WESTLOCK PL
LAUREL MD
20708-2422
US

IV. Provider business mailing address

12106 WESTLOCK PL
LAUREL MD
20708-2422
US

V. Phone/Fax

Practice location:
  • Phone: 240-260-8656
  • Fax:
Mailing address:
  • Phone: 240-260-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200004700
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: