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General NPI Number Information
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NPI Number | 1669124301
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Entity Type | Individual
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Provider Name | MRS. CRYSTALL M SISCO
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1607 MELFORD BLVD SUITE 400
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City | BOWIE
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State | MD
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Zip | 20715-4305
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Country | US
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Telephone | 202-878-6626
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Fax |
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Provider Business Mailing Address
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Address Line | 13324 BURLEIGH ST
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-1961
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Country | US
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Telephone | 202-498-4460
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LG200001469
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License Number State | DC
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