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General NPI Number Information
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NPI Number | 1316586688
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Entity Type | Individual
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Provider Name | MONTRELL PRYOR MED, LMSW
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Gender | Male
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 712 H ST NE STE 2884
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City | WASHINGTON
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State | DC
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Zip | 20002-3627
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Country | US
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Telephone | 615-635-8090
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Fax |
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Provider Business Mailing Address
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Address Line | 6304 WOODSIDE CT STE 110G
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City | COLUMBIA
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State | MD
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Zip | 21046-3217
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Country | US
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Telephone | 410-855-4631
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC200002964
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License Number State | DC
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