Healthcare Provider Details

I. General information

NPI: 1114190998
Provider Name (Legal Business Name): ELIZA CALHOUN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13219 EXECUTIVE PARK TER
GERMANTOWN MD
20874-2647
US

IV. Provider business mailing address

13219 EXECUTIVE PARK TER
GERMANTOWN MD
20874-2647
US

V. Phone/Fax

Practice location:
  • Phone: 718-578-9813
  • Fax:
Mailing address:
  • Phone: 718-578-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number085173
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004614
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009980
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50081362
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00947665
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22741
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: