Provider Demographics
NPI:1083139851
Name:GLYMPH, MYLA
Entity Type:Individual
Prefix:
First Name:MYLA
Middle Name:
Last Name:GLYMPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 K ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5516 NANNIE HELEN BURROUGHS AVE NE APT 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6790
Practice Address - Country:US
Practice Address - Phone:202-607-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant