Provider Demographics
NPI:1235560913
Name:MWANGACUCU, JEANNETTE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:MWANGACUCU
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 STANMORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705
Mailing Address - Country:US
Mailing Address - Phone:301-693-4888
Mailing Address - Fax:301-693-4888
Practice Address - Street 1:7602 STANMORE DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1383
Practice Address - Country:US
Practice Address - Phone:301-675-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker