Healthcare Provider Details

I. General information

NPI: 1063030336
Provider Name (Legal Business Name): ESTHER VANESSA ROCHA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 OLD GEORGETOWN RD
BETHESDA MD
20814-1620
US

IV. Provider business mailing address

15313 GABLE RIDGE CT APT N
ROCKVILLE MD
20850-4606
US

V. Phone/Fax

Practice location:
  • Phone: 301-493-2400
  • Fax:
Mailing address:
  • Phone: 240-361-7897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26002
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: