Healthcare Provider Details

I. General information

NPI: 1669865523
Provider Name (Legal Business Name): MARY IADAROLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 HAMAKER CT STE 450
FAIRFAX VA
22031-2237
US

IV. Provider business mailing address

200 WOOD HILL RD
ROCKVILLE MD
20850-8724
US

V. Phone/Fax

Practice location:
  • Phone: 240-800-5772
  • Fax:
Mailing address:
  • Phone: 703-204-9100
  • Fax: 301-610-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06664
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904008879
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: