Healthcare Provider Details

I. General information

NPI: 1679315634
Provider Name (Legal Business Name): EMOTIONAL AND BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ELLINGTON BLVD # 361
GAITHERSBURG MD
20878-4591
US

IV. Provider business mailing address

325 ELLINGTON BLVD # 361
GAITHERSBURG MD
20878-4591
US

V. Phone/Fax

Practice location:
  • Phone: 301-825-9392
  • Fax: 301-825-9392
Mailing address:
  • Phone: 301-825-9392
  • Fax: 301-825-9392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMIR JAHANSIR
Title or Position: PSYCHOTHERAPIST, LCSW-C
Credential: LCSWC
Phone: 301-825-9392