Provider Demographics
NPI:1407260763
Name:SUBURBAN HOSPITAL
Entity Type:Organization
Organization Name:SUBURBAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE-DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-896-6608
Mailing Address - Street 1:6001 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4817
Mailing Address - Country:US
Mailing Address - Phone:301-896-6616
Mailing Address - Fax:301-881-7428
Practice Address - Street 1:6001 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4817
Practice Address - Country:US
Practice Address - Phone:301-896-6616
Practice Address - Fax:301-881-7428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13431OtherSTATE OF MD LICENSED CERTIFIED SOCIAL WORKER