Basic Information
| Provider Information | |||||||||
| NPI: | 1720713746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | FRIEDMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 STUART CT | ||||||||
| Address2: | |||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201705435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023449659 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3912 GEORGIA AVE NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200115861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8447962797 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2022 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.