Basic Information
| Provider Information | |||||||||
| NPI: | 1487977401 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEWISH SOCIAL SERVICE AGENCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 WOOD HILL RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208508724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018384200 | ||||||||
| FaxNumber: | 3013092596 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 WOOD HILL RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208508724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018384200 | ||||||||
| FaxNumber: | 3013092596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2010 | ||||||||
| LastUpdateDate: | 03/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | PARKER-PEREZ | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3016108391 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 104100000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 101YP2500X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 5899245 | 01 | MD | AETNA | OTHER | A284 | 01 | DC | BCBS OF DC | OTHER | 416990500 | 05 | MD | MEDICAID | 100490 | 01 | MD | KAISER | OTHER | H564JE | 01 | MD | BCBS OF MD | OTHER |