Healthcare Provider Details

I. General information

NPI: 1821362617
Provider Name (Legal Business Name): CAM TU THI VU LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11002 VEIRS MILL RD # 705
SILVER SPRING MD
20902-2574
US

IV. Provider business mailing address

11002 VEIRS MILL RD # 705
SILVER SPRING MD
20902-2574
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-3206
  • Fax:
Mailing address:
  • Phone: 240-777-3206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17156
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1821362617
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: