Healthcare Provider Details

I. General information

NPI: 1619387933
Provider Name (Legal Business Name): MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 CALHOUN PL STE 600
ROCKVILLE MD
20855-3701
US

IV. Provider business mailing address

401 HUNGERFORD DR STE 600
ROCKVILLE MD
20850-4154
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-1450
  • Fax:
Mailing address:
  • Phone: 240-777-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

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