Provider Demographics
NPI:1194301465
Name:MCKINNEY, BIBHIAM M (LICSW)
Entity type:Individual
Prefix:MRS
First Name:BIBHIAM
Middle Name:M
Last Name:MCKINNEY
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:BIBHIAM
Other - Middle Name:M
Other - Last Name:CABRAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:15912 CRAIN HWY UNIT B #251
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613
Mailing Address - Country:US
Mailing Address - Phone:202-681-6761
Mailing Address - Fax:
Practice Address - Street 1:9075 N LAUREL RD UNIT K
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1570
Practice Address - Country:US
Practice Address - Phone:202-681-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040174411041C0700X
DCLC200002651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical