Provider Demographics
NPI:1649218181
Name:GANGINIS, IRENE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:GANGINIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 WESTLAKE DR
Mailing Address - Street 2:UNIT S104
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6449
Mailing Address - Country:US
Mailing Address - Phone:301-461-4400
Mailing Address - Fax:
Practice Address - Street 1:12 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4238
Practice Address - Country:US
Practice Address - Phone:301-461-4400
Practice Address - Fax:301-770-0731
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD434080900Medicaid
MD434080900Medicaid