Healthcare Provider Details

I. General information

NPI: 1164396933
Provider Name (Legal Business Name): ALON JACOB RAVEH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18310 MONTGOMERY VILLAGE AVE STE 500
GAITHERSBURG MD
20879-3553
US

IV. Provider business mailing address

18310 MONTGOMERY VILLAGE AVE STE 500
GAITHERSBURG MD
20879-3553
US

V. Phone/Fax

Practice location:
  • Phone: 301-683-9816
  • Fax: 301-683-7863
Mailing address:
  • Phone: 301-683-9816
  • Fax: 301-683-7863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number30305
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: