Healthcare Provider Details

I. General information

NPI: 1699239582
Provider Name (Legal Business Name): JEWISH SOCIAL SERVICE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 GEORGIA AVE
SILVER SPRING MD
20902-5244
US

IV. Provider business mailing address

9900 GEORGIA AVE
SILVER SPRING MD
20902-5244
US

V. Phone/Fax

Practice location:
  • Phone: 301-587-9666
  • Fax: 301-587-1541
Mailing address:
  • Phone: 301-587-9666
  • Fax: 301-587-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: JAKIE RICE
Title or Position: CREDENTIALING CONTACT
Credential:
Phone: 301-610-8306