Healthcare Provider Details

I. General information

NPI: 1609304989
Provider Name (Legal Business Name): CARON TRESINA STAROBIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 OLANDWOOD CT STE 104
OLNEY MD
20832-1489
US

IV. Provider business mailing address

3413 OLANDWOOD CT STE 104
OLNEY MD
20832-1489
US

V. Phone/Fax

Practice location:
  • Phone: 301-524-4450
  • Fax: 301-524-4450
Mailing address:
  • Phone: 301-524-4450
  • Fax: 301-524-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12565
License Number StateMD

VIII. Authorized Official

Name: MS. CARON TRESINA STAROBIN
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW
Phone: 301-524-4450