Provider Demographics
NPI:1457097271
Name:JALLOH, RUQAYYAH (LGSW)
Entity Type:Individual
Prefix:
First Name:RUQAYYAH
Middle Name:
Last Name:JALLOH
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 1:2218 RHODE ISLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2827
Mailing Address - Country:US
Mailing Address - Phone:202-717-9428
Mailing Address - Fax:
Practice Address - Street 1:8502 OKEEFE DR
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-3136
Practice Address - Country:US
Practice Address - Phone:301-256-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50081568104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker