Healthcare Provider Details

I. General information

NPI: 1710283627
Provider Name (Legal Business Name): MARIE LOUISE PASTI LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberG11673
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: