Healthcare Provider Details

I. General information

NPI: 1043680143
Provider Name (Legal Business Name): MARY LYNN PRICE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14915 BROSCHART RD STE 2200
ROCKVILLE MD
20850-3350
US

IV. Provider business mailing address

13600 MOUNT PROSPECT DR
ROCKVILLE MD
20850-3516
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-4912
  • Fax:
Mailing address:
  • Phone: 301-838-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16081
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27288
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: