MEDICARE: ODELIA MUIR LCSW-C, LICSW

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	101YM0800X	Mental Health Counselor	19640	MD
2	106H00000X	Marriage & Family Therapist	19640	MD
3	1041C0700X	Clinical Social Worker	19640	MD
4	1041C0700X	Clinical Social Worker	LC50080241	DC
5	106H00000X	Marriage & Family Therapist	LC50080241	DC
6	101YP2500X	Professional Counselor	LC50080241	DC
7	101YM0800X	Mental Health Counselor	LC50080241	DC
8	101YA0400X	Addiction (Substance Use Disorder) Counselor	LC50080241	DC
9	101YP2500X	Professional Counselor	19640	MD
10	101YA0400X	Addiction (Substance Use Disorder) Counselor	19640	MD

General Provider Information

NPI Number	:	1275898751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODELIA MUIR LCSW-C, LICSW

Provider Business Mailing Address
First Line	:	13184 LARCHDALE RD
Second Line	:	APT #6
City	:	LAUREL
State	:	MD
Zip	:	20708-1707
Country	:	US
Telephone Number	:	202-489-2066
Fax Number	:	877-409-9940

Provider Business Practice Location Address
First Line	:	13184 LARCHDALE RD
Second Line	:	APT #6
City	:	LAUREL
State	:	MD
Zip	:	20708-1707
Country	:	US
Telephone Number	:	202-489-2066
Fax Number	:	877-409-9940

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

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/01/2016

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