MEDICARE: MR. RYAN MALPHRUS 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	1041S0200X	School Social Worker	18660	MD

General Provider Information

NPI Number	:	1952765109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN MALPHRUS LCSW-C

Provider Business Mailing Address
First Line	:	5100 PHILADELPHIA WAY
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4412
Country	:	US
Telephone Number	:	301-429-6191
Fax Number	:	301-429-6194

Provider Business Practice Location Address
First Line	:	5100 PHILADELPHIA WAY
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4412
Country	:	US
Telephone Number	:	301-429-6191
Fax Number	:	301-429-6194

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

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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