MEDICARE: DEBORAH ENYIDAH LCSW-C

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	1041C0700X	Clinical Social Worker	19820	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134664519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ENYIDAH LCSW-C

Provider Business Mailing Address
First Line	:	120 SISTER PIERRE DR STE 403
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-7536
Country	:	US
Telephone Number	:	410-823-6408
Fax Number	:	443-279-0537

Provider Business Practice Location Address
First Line	:	604 S FREDERICK AVE STE 211
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1282
Country	:	US
Telephone Number	:	410-823-6408
Fax Number	:	443-279-0537

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

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	12/09/2025

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