Provider Demographics
NPI:1457864290
Name:ANEW THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:ANEW THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW-C, LICSW
Authorized Official - Phone:240-473-2313
Mailing Address - Street 1:137 WESTWAY APT 102
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1991
Mailing Address - Country:US
Mailing Address - Phone:240-473-2313
Mailing Address - Fax:
Practice Address - Street 1:9500 ARENA DR STE 460C
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3755
Practice Address - Country:US
Practice Address - Phone:240-473-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18124251S00000X
DCLC50078379251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health