Provider Demographics
NPI:1124822416
Name:HERMIONNES, MABIAMA
Entity type:Individual
Prefix:
First Name:MABIAMA
Middle Name:
Last Name:HERMIONNES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 RIGGS RD
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1208
Mailing Address - Country:US
Mailing Address - Phone:240-424-7156
Mailing Address - Fax:
Practice Address - Street 1:10111 RIGGS RD
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1208
Practice Address - Country:US
Practice Address - Phone:240-424-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator