MEDICARE: ALDRIN OSVALDO CEBALLOS 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	1041C0700X	Clinical Social Worker	14168	MD

General Provider Information

NPI Number	:	1811275423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALDRIN OSVALDO CEBALLOS LCSW-C

Provider Business Mailing Address
First Line	:	20332 CEDARHURST WAY
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-5642
Country	:	US
Telephone Number	:	202-390-4487
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 S FREDERICK AVE
Second Line	:	STE 215
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1282
Country	:	US
Telephone Number	:	202-390-4487
Fax Number	:	301-740-2192

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

Provider Enumeration Date	:	07/31/2011
Last Update Date	:	03/19/2018

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