Healthcare Provider Details

I. General information

NPI: 1477311595
Provider Name (Legal Business Name): URBAN VILLAGE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 WILLARD AVE STE 600
CHEVY CHASE MD
20815-3786
US

IV. Provider business mailing address

4445 WILLARD AVE STE 600
CHEVY CHASE MD
20815-3786
US

V. Phone/Fax

Practice location:
  • Phone: 301-636-7324
  • Fax:
Mailing address:
  • Phone: 301-636-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA DRVOSHANOV
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSYD
Phone: 301-636-7324