Provider Demographics
NPI:1205388436
Name:ROSALES MARROQUIN, GABRIELA ELIZABETH (LGSW)
Entity Type:Individual
Prefix:MS
First Name:GABRIELA
Middle Name:ELIZABETH
Last Name:ROSALES MARROQUIN
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4340
Mailing Address - Country:US
Mailing Address - Phone:240-505-8493
Mailing Address - Fax:
Practice Address - Street 1:8757 GEORGIA AVE FL 10
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3737
Practice Address - Country:US
Practice Address - Phone:301-628-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21348104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21348OtherMARYLAND BOARD OF SOCIAL WORK EXAMINERS