1730293788 NPI number — MS. ANNA MARIE GORDIN LCSW C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730293788 NPI number — MS. ANNA MARIE GORDIN LCSW C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDIN
Provider First Name:
ANNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
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:
1730293788
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:
6123 MONTROSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-881-3700
Provider Business Mailing Address Fax Number:
301-468-1862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11B FIRST FIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-990-6880
Provider Business Practice Location Address Fax Number:
301-990-0257
Provider Enumeration Date:
08/18/2006

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: 104100000X , with the licence number:  1929 , 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: A2840030 . This is a "BCBS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 54062 . This is a "UBH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 233482 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7785115 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 96459 . This is a "MNH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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