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General NPI Number Information
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NPI Number | 1811775943
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Entity Type | Individual
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Provider Name | TRAEQUANDA BROCK LGSW, LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 440 PENN ST NE APT 520
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City | WASHINGTON
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State | DC
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Zip | 20002-8373
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Country | US
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Telephone | 518-364-4481
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 MERCANTILE LN STE 433
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-4301
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Country | US
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Telephone | 518-364-4481
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Fax | 240-823-1424
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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 | LG50083546
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL07023200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 26217
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License Number State | MD
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