Provider Demographics
NPI:1326570680
Name:LASOSKI, HEIKE
Entity Type:Individual
Prefix:
First Name:HEIKE
Middle Name:
Last Name:LASOSKI
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 1:173 ST. PATRICK'S DR.
Mailing Address - Street 2:STE 104 PMB 1011
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603
Mailing Address - Country:US
Mailing Address - Phone:240-925-9000
Mailing Address - Fax:301-475-5817
Practice Address - Street 1:173 ST. PATRICK'S DR.
Practice Address - Street 2:STE 104 PMB 1011
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603
Practice Address - Country:US
Practice Address - Phone:240-925-9000
Practice Address - Fax:301-475-5817
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD180731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical