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General NPI Number Information
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NPI Number | 1376724492
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Entity Type | Individual
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Provider Name | MITRA KHANJANI LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 244 MAIN ST SUITE 200
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5588
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Country | US
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Telephone | 301-343-4475
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Fax | 301-515-3676
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Provider Business Mailing Address
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Address Line | 13104 LAKE GENEVA WAY
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City | GERMANTOWN
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State | MD
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Zip | 20874-1867
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Country | US
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Telephone | 301-343-4475
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Fax | 301-515-3676
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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 | 013146
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License Number State | MD
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