Healthcare Provider Details

I. General information

NPI: 1356468268
Provider Name (Legal Business Name): LAURIE L EDMOND LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PICCARD DR
ROCKVILLE MD
20850-4320
US

IV. Provider business mailing address

3463 HEWITT AVE
SILVER SPRING MD
20906-5444
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-4000
  • Fax:
Mailing address:
  • Phone: 301-463-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13259
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: