MEDICARE: JOY PETWAY

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	17236	MD
2	1041C0700X	Clinical Social Worker	LC50079818	DC

General Provider Information

NPI Number	:	1770970063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY PETWAY

Provider Business Mailing Address
First Line	:	5202 56TH AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-2903
Country	:	US
Telephone Number	:	757-719-1926
Fax Number	:	301-779-1789

Provider Business Practice Location Address
First Line	:	9701 APOLLO DR
Second Line	:	STE 400
City	:	LARGO
State	:	MD
Zip	:	20774-4791
Country	:	US
Telephone Number	:	301-772-0105
Fax Number	:	301-772-0103

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

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	12/16/2020

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Directions to “ JOY PETWAY ” Practice Location

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