Healthcare Provider Details

I. General information

NPI: 1184276347
Provider Name (Legal Business Name): ELSA MENDEZ LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10411 MOTOR CITY DRIVE
BETHESDA MD
20817
US

IV. Provider business mailing address

1101 IVY CLUB LN UNIT 122
LANDOVER MD
20785-4508
US

V. Phone/Fax

Practice location:
  • Phone: 703-552-2722
  • Fax:
Mailing address:
  • Phone: 202-487-8894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG50082183
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: