Provider Demographics
NPI:1104838804
Name:VASSALLO, JANICE NANCY (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:NANCY
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19357 KAYMAR WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20886
Mailing Address - Country:US
Mailing Address - Phone:240-449-5517
Mailing Address - Fax:
Practice Address - Street 1:2275 RESEARCH BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3268
Practice Address - Country:US
Practice Address - Phone:240-449-5517
Practice Address - Fax:301-330-8874
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional