Provider Demographics
NPI:1043895584
Name:LUGUTERAH, MERCY (LMSW)
Entity type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:LUGUTERAH
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 1:518 S CAMP MEADE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2766
Mailing Address - Country:US
Mailing Address - Phone:443-354-8903
Mailing Address - Fax:443-410-0643
Practice Address - Street 1:518 S CAMP MEADE RD STE 4-5
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2766
Practice Address - Country:US
Practice Address - Phone:443-354-8903
Practice Address - Fax:443-410-0643
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD265411041C0700X
DCLG200001521104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD26541OtherBOARD OF SOCIAL WORK EXAMINERS