Healthcare Provider Details

I. General information

NPI: 1861697823
Provider Name (Legal Business Name): SPANISH CATHOLIC CHARITIES CATHOLIC COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12247 GEORGIA AVE
SILVER SPRING MD
20902-5523
US

IV. Provider business mailing address

12247 GEORGIA AVE
SILVER SPRING MD
20902-5523
US

V. Phone/Fax

Practice location:
  • Phone: 301-434-8385
  • Fax: 301-434-8067
Mailing address:
  • Phone: 301-434-8385
  • Fax: 301-434-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberR096580
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANNA MARIA IZQUIERDO
Title or Position: DIRECTOR
Credential: M.D.
Phone: 202-939-2412