Provider Demographics
NPI:1093303836
Name:MOTLAGH-HARVEY, AUDRY SORAYA (LCSW-C, MPH)
Entity type:Individual
Prefix:
First Name:AUDRY
Middle Name:SORAYA
Last Name:MOTLAGH-HARVEY
Suffix:
Gender:F
Credentials:LCSW-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 SOUTH RD APT 3W
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4571
Mailing Address - Country:US
Mailing Address - Phone:912-247-8802
Mailing Address - Fax:
Practice Address - Street 1:5508 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1615
Practice Address - Country:US
Practice Address - Phone:410-343-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD212471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical