Healthcare Provider Details

I. General information

NPI: 1164356267
Provider Name (Legal Business Name): MONIQUE BOYD LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 BENNERTON DR
NOTTINGHAM MD
21236-3801
US

IV. Provider business mailing address

4555 BENNERTON DR
NOTTINGHAM MD
21236-3801
US

V. Phone/Fax

Practice location:
  • Phone: 410-905-9440
  • Fax:
Mailing address:
  • Phone: 410-905-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25748
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25748
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number25748
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25748
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: