Healthcare Provider Details

I. General information

NPI: 1174776900
Provider Name (Legal Business Name): JEWISH SOCIAL SERVICE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WOOD HILL RD
ROCKVILLE MD
20850-8724
US

IV. Provider business mailing address

200 WOOD HILL RD
ROCKVILLE MD
20850-8724
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-4200
  • Fax: 301-309-2596
Mailing address:
  • Phone: 301-838-4200
  • Fax: 301-309-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROL PARKER-PEREZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 301-838-4200