Healthcare Provider Details

I. General information

NPI: 1750858239
Provider Name (Legal Business Name): LAUREN LOSAK LCSW - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15204 OMEGA DRIVE SUITE 200
ROCKVILLE MD
20850
US

IV. Provider business mailing address

15204 OMEGA DRIVE SUITE 200
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 301-279-6750
  • Fax: 301-208-8953
Mailing address:
  • Phone: 301-279-6750
  • Fax: 301-208-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: