Healthcare Provider Details

I. General information

NPI: 1275638256
Provider Name (Legal Business Name): DEBBY VAJDA LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 SHADY GROVE CT
GAITHERSBURG MD
20877-1308
US

IV. Provider business mailing address

8929 SHADY GROVE CT
GAITHERSBURG MD
20877-1308
US

V. Phone/Fax

Practice location:
  • Phone: 301-340-8650
  • Fax:
Mailing address:
  • Phone: 301-340-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01361
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: