Healthcare Provider Details

I. General information

NPI: 1255841078
Provider Name (Legal Business Name): TRISHA NICOLE UNGAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 SOLOMONS ISLAND RD N # 1046
PRINCE FREDERICK MD
20678-3915
US

IV. Provider business mailing address

645 SOLOMONS ISLAND RD N # 1046
PRINCE FREDERICK MD
20678-3915
US

V. Phone/Fax

Practice location:
  • Phone: 443-440-5484
  • Fax:
Mailing address:
  • Phone: 443-440-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010035
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: