Provider Demographics
NPI:1023714540
Name:MUENTES, ANTHONY JAVIER
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAVIER
Last Name:MUENTES
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 1:1645 LIBERTY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6537
Mailing Address - Country:US
Mailing Address - Phone:443-328-4946
Mailing Address - Fax:
Practice Address - Street 1:1645 LIBERTY RD STE 104
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6537
Practice Address - Country:US
Practice Address - Phone:443-328-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty