Deitra E. Bryant-Mallory, LICSW, LCSW-C
NPI 1063719060ActiveIndividual· Social Worker, Clinical· Lanham, MD
Social Worker, Clinical (LICSW, LCSW-C) in Lanham, Maryland, licensed in MD and DC, with an NPI issued in February 2011. Enrolled in Medicare as practitioner - clinical social worker.
Overview
| NPI | 1063719060 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LICSW, LCSW-C |
| Sole proprietor | Yes |
| NPI issued | Feb 28, 2011 |
| Last updated in NPPES | May 22, 2026 |
| Certified by provider | May 22, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | 13673 | MD |
| Social Worker, Clinical | 1041C0700X | LC50078061 | DC |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Social Worker (DC) |
|---|
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