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General NPI Number Information
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NPI Number | 1104486216
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Entity Type | Individual
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Provider Name | MORGAN RIAN WIDERMAN LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 11140 ROCKVILLE PIKE
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City | ROCKVILLE
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State | MD
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Zip | 20852-3106
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Country | US
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Telephone | 443-302-9716
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Fax |
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Provider Business Mailing Address
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Address Line | 11140 ROCKVILLE PIKE SUITE 100 #371
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City | ROCKVILLE
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State | MD
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Zip | 20852
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23085
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License Number State | MD
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