Provider Demographics
NPI:1225786502
Name:BLOUNT-TATE, ZURI AMIR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ZURI
Middle Name:AMIR
Last Name:BLOUNT-TATE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 BELCREST CENTER WAY APT 206
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2974
Mailing Address - Country:US
Mailing Address - Phone:202-730-6806
Mailing Address - Fax:
Practice Address - Street 1:3011 BELCREST CENTER WAY APT 206
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2974
Practice Address - Country:US
Practice Address - Phone:202-730-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50080455104100000X
MD19224104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker