Healthcare Provider Details

I. General information

NPI: 1578471454
Provider Name (Legal Business Name): CARLOS MORA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 QUINCE ORCHARD RD # 250
GAITHERSBURG MD
20878-1437
US

IV. Provider business mailing address

110 E DEER PARK DR
GAITHERSBURG MD
20877-2031
US

V. Phone/Fax

Practice location:
  • Phone: 484-202-0751
  • Fax:
Mailing address:
  • Phone: 240-281-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31070
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: