Healthcare Provider Details

I. General information

NPI: 1093418709
Provider Name (Legal Business Name): ROSEMARY FAJEMISIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2759 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-2646
US

IV. Provider business mailing address

5328 CRITTENDEN ST
HYATTSVILLE MD
20781-2633
US

V. Phone/Fax

Practice location:
  • Phone: 202-827-9961
  • Fax:
Mailing address:
  • Phone: 301-755-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50082348
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: