Provider Demographics
NPI:1013522762
Name:FORDAY-WATSON, ANDREW MUSA (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MUSA
Last Name:FORDAY-WATSON
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:MR
Other - First Name:A. MUSA
Other - Middle Name:
Other - Last Name:FORDAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:1451 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5901
Mailing Address - Country:US
Mailing Address - Phone:443-977-3048
Mailing Address - Fax:
Practice Address - Street 1:1451 DARTMOUTH AVE
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5901
Practice Address - Country:US
Practice Address - Phone:443-977-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD197481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical