Basic Information
| Provider Information | |||||||||
| NPI: | 1730293788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORDIN | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6123 MONTROSE RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018813700 | ||||||||
| FaxNumber: | 3014681862 | ||||||||
| Practice Location | |||||||||
| Address1: | 11B FIRST FIELD RD | ||||||||
| Address2: | |||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019906880 | ||||||||
| FaxNumber: | 3019900257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 1929 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | A2840030 | 01 | DC | BCBS OF DC | OTHER | 54062 | 01 | MD | UBH | OTHER | 233482 | 01 | MD | KAISER | OTHER | 7785115 | 01 | MD | AETNA | OTHER | 96459 | 01 | MD | MNH | OTHER |