MEDICARE: MONTRELL PRYOR MED, 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	1041C0700X	Clinical Social Worker	LC200002964	DC

General Provider Information

NPI Number	:	1316586688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONTRELL PRYOR MED, LMSW

Provider Business Mailing Address
First Line	:	6304 WOODSIDE CT STE 110G
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3217
Country	:	US
Telephone Number	:	410-855-4631
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 H ST NE STE 2884
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3627
Country	:	US
Telephone Number	:	615-635-8090
Fax Number	:

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

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	02/28/2024

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