Healthcare Provider Details

I. General information

NPI: 1265906259
Provider Name (Legal Business Name): MARIA CECELIA HERALD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 BROSCHART RD
ROCKVILLE MD
20850-3318
US

IV. Provider business mailing address

19805 APPLE RIDGE PL
GAITHERSBURG MD
20886-1039
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-6047
  • Fax: 301-838-4913
Mailing address:
  • Phone: 240-575-0583
  • Fax: 301-838-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23814
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23814
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23814
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: