Healthcare Provider Details

I. General information

NPI: 1386943512
Provider Name (Legal Business Name): ROBERT MICHAEL GUTTENBERG L.C.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 10/15/2018
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

14029 GREAT NOTCH TER
NORTH POTOMAC MD
20878-4237
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-4200
  • Fax: 301-468-1862
Mailing address:
  • Phone: 301-545-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCO797
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: