Provider Demographics
NPI:1265643514
Name:MORDI, ROSELINE
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:MORDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14356 ROSETREE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1941
Mailing Address - Country:US
Mailing Address - Phone:240-277-4832
Mailing Address - Fax:
Practice Address - Street 1:9301 ANNAPOLIS RD STE 100
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3133
Practice Address - Country:US
Practice Address - Phone:240-296-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12200104100000X
MD23137104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLG50078205Medicare ID - Type UnspecifiedLGSW
DCLG50078205Medicare ID - Type UnspecifiedLGSW