MEDICARE: LITICIA CHOU MBENG

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	374U00000X	Home Health Aide
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1912792474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LITICIA CHOU MBENG

Provider Business Mailing Address
First Line	:	10405 GRANDHAVEN AVE
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-6626
Country	:	US
Telephone Number	:	240-524-8835
Fax Number	:

Provider Business Practice Location Address
First Line	:	10405 GRANDHAVEN AVE
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-6626
Country	:	US
Telephone Number	:	240-524-8835
Fax Number	:

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

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	12/11/2025

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Directions to “ LITICIA CHOU MBENG ” Practice Location

Language	Start Address	Practice Location

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