Provider Demographics
NPI:1912520339
Name:MUJENYI, SIMA JOAN (LMSW)
Entity type:Individual
Prefix:MS
First Name:SIMA
Middle Name:JOAN
Last Name:MUJENYI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PATTERSON RD # 464542
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4717
Mailing Address - Country:US
Mailing Address - Phone:347-833-0428
Mailing Address - Fax:770-922-5164
Practice Address - Street 1:3400 SWEETWATER RD APT 1303
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2494
Practice Address - Country:US
Practice Address - Phone:347-833-0428
Practice Address - Fax:770-922-5164
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GAMSW008121104100000X
GACSW0080781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA101201Medicaid