Provider Demographics
NPI:1134737349
Name:MANSARAY, MOHAMED LAMIN
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:LAMIN
Last Name:MANSARAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9737 MOUNT PISGAH RD APT 1210
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2017
Mailing Address - Country:US
Mailing Address - Phone:240-828-9736
Mailing Address - Fax:
Practice Address - Street 1:9737 MOUNT PISGAH RD APT 1210
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2017
Practice Address - Country:US
Practice Address - Phone:240-828-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-20-123521103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty