Provider Demographics
NPI:1508454018
Name:MUGAMBA, JOSEPH (MS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:MUGAMBA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 NATIONAL DR STE 230
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-6101
Mailing Address - Country:US
Mailing Address - Phone:240-650-0779
Mailing Address - Fax:443-583-3872
Practice Address - Street 1:3905 NATIONAL DR STE 360
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-6120
Practice Address - Country:US
Practice Address - Phone:240-650-0779
Practice Address - Fax:443-583-3872
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0157103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities