=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700254950
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSE BLEIWEIS LGSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2015
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 OLNEY SANDY SPRING RD STE 340
-----------------------------------------------------
City | OLNEY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20832-3306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-389-0753
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1155 RIPLEY ST APT 705
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-7456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-461-4619
-----------------------------------------------------
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 | 20839
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------