MEDICARE: MS. DESIREE GOUGHERTY GHARAKHANIAN

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	390200000X	Student in an Organized Health Care Education/Training Program
2	104100000X	Social Worker	20624	MD

General Provider Information

NPI Number	:	1922420041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DESIREE GOUGHERTY GHARAKHANIAN

Provider Business Mailing Address
First Line	:	1553 MERRITT BLVD
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-2113
Country	:	US
Telephone Number	:	410-282-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1553 MERRITT BLVD
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-2113
Country	:	US
Telephone Number	:	410-282-6144
Fax Number	:

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

Provider Enumeration Date	:	01/08/2014
Last Update Date	:	04/13/2015

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