Healthcare Provider Details

I. General information

NPI: 1487317889
Provider Name (Legal Business Name): NASIM AMERI CIANAKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 PONTIAC WAY
GAITHERSBURG MD
20878-2792
US

IV. Provider business mailing address

14078 BERRYVILLE RD
GERMANTOWN MD
20874-3520
US

V. Phone/Fax

Practice location:
  • Phone: 301-275-5905
  • Fax:
Mailing address:
  • Phone: 301-275-5905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC15449
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: