Healthcare Provider Details

I. General information

NPI: 1588076897
Provider Name (Legal Business Name): ELIZABETH ANNE NELSON L.G.S.W., B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E DIAMOND AVE SUITE 100
GAITHERSBURG MD
20877-5321
US

IV. Provider business mailing address

45 CRESTED IRIS CT
MONTGOMERY VILLAGE MD
20886-1025
US

V. Phone/Fax

Practice location:
  • Phone: 301-840-3200
  • Fax:
Mailing address:
  • Phone: 208-440-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21009
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: