Provider Demographics
NPI:1740329010
Name:MUNOZ, NICOLE (LCSWC CCDC LLC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:LCSWC CCDC LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 DULANEY VALLEY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5132
Mailing Address - Country:US
Mailing Address - Phone:410-494-6668
Mailing Address - Fax:443-403-2566
Practice Address - Street 1:744 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:410-494-6668
Practice Address - Fax:443-403-2566
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11819104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401199600Medicaid