MEDICARE: SILVIA LEYDI FUENTES VASQUEZ LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	25388	MD
2	1041C0700X	Clinical Social Worker	25388	MD

General Provider Information

NPI Number	:	1306496781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SILVIA LEYDI FUENTES VASQUEZ LCSW-C

Provider Business Mailing Address
First Line	:	13415 CONNECTICUT AVE STE 100
Second Line	:
City	:	ASPEN HILL
State	:	MD
Zip	:	20906-2910
Country	:	US
Telephone Number	:	301-557-2152
Fax Number	:	301-557-2141

Provider Business Practice Location Address
First Line	:	13415 CONNECTICUT AVE STE 100
Second Line	:
City	:	ASPEN HILL
State	:	MD
Zip	:	20906-2910
Country	:	US
Telephone Number	:	301-557-2152
Fax Number	:	301-557-2141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	01/27/2025

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