Basic Information
| Provider Information | |||||||||
| NPI: | 1770184988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REXRODE | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | ALICE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1003 W 7TH ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217018512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013451022 | ||||||||
| FaxNumber: | 3015605558 | ||||||||
| Practice Location | |||||||||
| Address1: | 16220 FREDERICK RD | ||||||||
| Address2: | |||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208774039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013584388 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2020 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 26431 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.