Provider Demographics
NPI:1093442022
Name:GARRETT, MARK (LMSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GARRETT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 EXECUTIVE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3822
Mailing Address - Country:US
Mailing Address - Phone:301-473-3907
Mailing Address - Fax:
Practice Address - Street 1:6010 EXECUTIVE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3822
Practice Address - Country:US
Practice Address - Phone:301-473-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD286581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical