Healthcare Provider Details

I. General information

NPI: 1578467254
Provider Name (Legal Business Name): EARLY CHILDHOOD INTERVENTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 CONSERVATION LN STE 300
GAITHERSBURG MD
20878-2983
US

IV. Provider business mailing address

707 CONSERVATION LN STE 300
GAITHERSBURG MD
20878-2983
US

V. Phone/Fax

Practice location:
  • Phone: 301-208-1032
  • Fax: 877-497-1029
Mailing address:
  • Phone: 301-208-1032
  • Fax: 877-497-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JOHN GOTLEWSKI
Title or Position: OWNER
Credential: PSY.D.
Phone: 301-208-1032