MEDICARE: MS. CAROLINE ICIEK LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	24523	MD

General Provider Information

NPI Number	:	1285271569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLINE ICIEK LMSW

Provider Business Mailing Address
First Line	:	4701 SANGAMORE RD STE N100
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20816-2558
Country	:	US
Telephone Number	:	240-780-8734
Fax Number	:

Provider Business Practice Location Address
First Line	:	9466 GEORGIA AVE # 504
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1456
Country	:	US
Telephone Number	:	240-780-8734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	07/15/2025

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