1457463408 NPI number — RHONA MELODY BOSIN LCSW-C

Table of content: RHONA MELODY BOSIN LCSW-C (NPI 1457463408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457463408 NPI number — RHONA MELODY BOSIN LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOSIN
Provider First Name:
RHONA
Provider Middle Name:
MELODY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457463408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 UNIVERSITY BLVD W
Provider Second Line Business Mailing Address:
1002
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-3351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-681-4562
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 TWINBROOK PKWY
Provider Second Line Business Practice Location Address:
THRESHOLD SERVICES
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20851-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-838-4100
Provider Business Practice Location Address Fax Number:
301-315-8331
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  11572 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 619516-01 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: QH81 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4013221 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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