Provider Demographics
NPI:1851150619
Name:MUGO, EUNICE
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:MUGO
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 1:19 WALKER AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4067
Mailing Address - Country:US
Mailing Address - Phone:443-213-8243
Mailing Address - Fax:
Practice Address - Street 1:19 WALKER AVE STE 304
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4067
Practice Address - Country:US
Practice Address - Phone:443-213-8243
Practice Address - Fax:443-808-0476
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool