MEDICARE: MRS. LIONELLE NANGE FUBE 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	27630	MD

General Provider Information

NPI Number	:	1134957400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIONELLE NANGE FUBE LCSW-C

Provider Business Mailing Address
First Line	:	8210 JEREMIAH LN
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-4165
Country	:	US
Telephone Number	:	240-423-8757
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 HARFORD RD
Second Line	:
City	:	PARKVILLE
State	:	MD
Zip	:	21234-4029
Country	:	US
Telephone Number	:	240-423-8757
Fax Number	:

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

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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Directions to “ MRS. LIONELLE NANGE FUBE LCSW-C” Practice Location

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