Provider Demographics
NPI:1235560913
Name:MWANGACUCU, JEANNETTE (LCSW-C)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:MWANGACUCU
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 STANMORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705
Mailing Address - Country:US
Mailing Address - Phone:301-693-4888
Mailing Address - Fax:301-693-4888
Practice Address - Street 1:12301 OLD COLUMBIA PIKE STE 201
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1656
Practice Address - Country:US
Practice Address - Phone:301-328-0101
Practice Address - Fax:301-328-0103
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker