Healthcare Provider Details

I. General information

NPI: 1992510184
Provider Name (Legal Business Name): ADELINE KASSAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 W SIDE BLVD APT 306
LAUREL MD
20707-6230
US

IV. Provider business mailing address

14200 W SIDE BLVD APT 306
LAUREL MD
20707-6230
US

V. Phone/Fax

Practice location:
  • Phone: 240-714-0303
  • Fax:
Mailing address:
  • Phone: 240-714-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG200004733
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: