Healthcare Provider Details

I. General information

NPI: 1780467571
Provider Name (Legal Business Name): FATIMA MASSAQUOI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3465 FORT MEADE RD # 109
LAUREL MD
20724-2044
US

IV. Provider business mailing address

613 DENHAM RD
ROCKVILLE MD
20851-1035
US

V. Phone/Fax

Practice location:
  • Phone: 240-863-2117
  • Fax: 240-912-9564
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number27208
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: