Provider Demographics
NPI:1699583039
Name:MUSIANI, PHYLICIA KIMMEL (LCSW-C)
Entity type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:KIMMEL
Last Name:MUSIANI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:PHYLICIA
Other - Middle Name:CATHERINE
Other - Last Name:KIMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:214 SCOTTS MANOR DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6287
Mailing Address - Country:US
Mailing Address - Phone:443-859-6629
Mailing Address - Fax:
Practice Address - Street 1:214 SCOTTS MANOR DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6287
Practice Address - Country:US
Practice Address - Phone:443-859-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD249421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical