Provider Demographics
NPI:1962037549
Name:JUDITH LYNN MOUNTY LCSW LLC
Entity Type:Organization
Organization Name:JUDITH LYNN MOUNTY LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MOUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:240-423-4863
Mailing Address - Street 1:508 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5802
Mailing Address - Country:US
Mailing Address - Phone:240-423-4863
Mailing Address - Fax:
Practice Address - Street 1:508 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5802
Practice Address - Country:US
Practice Address - Phone:240-423-4863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty