Healthcare Provider Details

I. General information

NPI: 1730487703
Provider Name (Legal Business Name): MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PICCARD DR 1ST FLOOR
ROCKVILLE MD
20850-4320
US

IV. Provider business mailing address

401 HUNGERFORD DR # 6TH
ROCKVILLE MD
20850-4154
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-4190
  • Fax:
Mailing address:
  • Phone: 240-777-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number22906
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number4782-06
License Number StateMD

VIII. Authorized Official

Name: DIANA AZUCENA CORTEZ
Title or Position: MANAGEMENT
Credential:
Phone: 240-672-6758