MEDICARE: EMAN MUSTAFA LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	26559	MD

General Provider Information

NPI Number	:	1104572726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMAN MUSTAFA LMSW

Provider Business Mailing Address
First Line	:	8511 LOCH RAVEN BLVD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-2302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8511 LOCH RAVEN BLVD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-2302
Country	:	US
Telephone Number	:	443-264-0127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/22/2022

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Directions to “ EMAN MUSTAFA LMSW” Practice Location

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