MEDICARE: MRS. LAKEIYA CHERRY MSW, LICSW, 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	LC50079358	DC
2	1041S0200X	School Social Worker	LC50079358	DC
3	1041C0700X	Clinical Social Worker	18165	MD

General Provider Information

NPI Number	:	1659618353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAKEIYA CHERRY MSW, LICSW, LCSW-C

Provider Business Mailing Address
First Line	:	3575 FORT MEADE RD APT 501
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-2039
Country	:	US
Telephone Number	:	301-221-9125
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 FORT MEADE RD APT 501
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-2039
Country	:	US
Telephone Number	:	301-221-9125
Fax Number	:

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

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	07/21/2022

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