Provider Demographics
NPI:1225337256
Name:NICOLE MUNOZ, LCSW-C, LLC
Entity Type:Organization
Organization Name:NICOLE MUNOZ, LCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST, BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-494-6668
Mailing Address - Street 1:744 DULANEY VALLEY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5132
Mailing Address - Country:US
Mailing Address - Phone:410-494-6668
Mailing Address - Fax:443-403-2566
Practice Address - Street 1:744 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:410-494-6668
Practice Address - Fax:443-403-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11819251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401199600Medicaid