Provider Demographics
NPI:1891157913
Name:MYFORD, DAVID LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LYNN
Last Name:MYFORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 PARK AVE APT 1209
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5646
Mailing Address - Country:US
Mailing Address - Phone:708-308-9064
Mailing Address - Fax:
Practice Address - Street 1:1020 PARK AVE APT 1209
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5646
Practice Address - Country:US
Practice Address - Phone:312-883-6936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0154511041C0700X
MD293181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL81-1718346OtherEIN