Provider Demographics
NPI:1134490568
Name:ROSENBLOOM, MAGGIE DARA (LICSW)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:DARA
Last Name:ROSENBLOOM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HOWARD UNIVERSITY HOSPITAL
Mailing Address - Street 2:2041 GEORGIA AVE NW- 5B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-7219
Mailing Address - Country:US
Mailing Address - Phone:202-865-6611
Mailing Address - Fax:
Practice Address - Street 1:HOWARD UNIVERSITY HOSPITAL
Practice Address - Street 2:2041 GEORGIA AVE NW- 5B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-7219
Practice Address - Country:US
Practice Address - Phone:202-865-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50079780104100000X
1041C0700X
DCLC500805821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker