=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609480235
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEAGHAN AUCHINCLOSS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2020
-----------------------------------------------------
Last Update Date | 05/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10607 OUTPOST DR
-----------------------------------------------------
City | NORTH POTOMAC
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20878-4359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-237-5134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 630 E DIAMOND AVE STE H
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-5322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-672-3435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 25978
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------