Healthcare Provider Details

I. General information

NPI: 1780557959
Provider Name (Legal Business Name): MS. MARISELA BOLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WISCONSIN CIR STE 700
CHEVY CHASE MD
20815-7007
US

IV. Provider business mailing address

2 WISCONSIN CIR STE 700
CHEVY CHASE MD
20815-7007
US

V. Phone/Fax

Practice location:
  • Phone: 202-436-2536
  • Fax:
Mailing address:
  • Phone: 202-436-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150118194
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023605
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: