=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235462334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN MICHAEL CLAXTON LCSW-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2009
-----------------------------------------------------
Last Update Date | 05/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 932 HUNGERFORD DR STE 18B
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-1751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-580-2886
-----------------------------------------------------
Fax | 301-740-1978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10620 CHISHOLM LANDING TER
-----------------------------------------------------
City | NORTH POTOMAC
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20878-4260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-580-2886
-----------------------------------------------------
Fax | 301-740-1978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 13139
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------