Healthcare Provider Details

I. General information

NPI: 1780083105
Provider Name (Legal Business Name): JESSICA L CAVUOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 BROSCHART RD
ROCKVILLE MD
20850-3303
US

IV. Provider business mailing address

8860 WOODLAND DR
SILVER SPRING MD
20910-2743
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05936
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: