MEDICARE: ROBIN RAY MUSTAIN MSW

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	05752	MD

General Provider Information

NPI Number	:	1548254386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN RAY MUSTAIN MSW

Provider Business Mailing Address
First Line	:	13100 DEER PATH LN
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-6321
Country	:	US
Telephone Number	:	301-528-0652
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 E WEST HWY
Second Line	:	SUITE 720
City	:	BETHESDA
State	:	MD
Zip	:	20814-4524
Country	:	US
Telephone Number	:	301-652-3744
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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