Basic Information
| Provider Information | |||||||||
| NPI: | 1568751287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAZDIK | ||||||||
| FirstName: | SONIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14320 BRIARWOOD TER | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208532217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014600051 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7474 GREENWAY CENTER DRIVE | ||||||||
| Address2: | SUITE 730 | ||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013451022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2011 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 15275 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 816700100 | 05 | MD | MEDICAID |