Provider Demographics
NPI:1770970063
Name:PETWAY, JOY
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:PETWAY
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 1:5202 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-2903
Mailing Address - Country:US
Mailing Address - Phone:757-719-1926
Mailing Address - Fax:301-779-1789
Practice Address - Street 1:9701 APOLLO DR
Practice Address - Street 2:STE 400
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4791
Practice Address - Country:US
Practice Address - Phone:301-772-0105
Practice Address - Fax:301-772-0103
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172361041C0700X
DCLC500798181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical