Provider Demographics
NPI:1477262996
Name:WIDENHOUSE, RACHEL G (LMSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:G
Last Name:WIDENHOUSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12051 PROSPERITY DRIVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12051 PROSPERITY DRIVE
Practice Address - Street 2:SUITE 350
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1699
Practice Address - Country:US
Practice Address - Phone:410-910-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28177104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker