Provider Demographics
NPI:1851303184
Name:PSKOWSKI, ELLEN C (LCSW-C LICSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:C
Last Name:PSKOWSKI
Suffix:
Gender:F
Credentials:LCSW-C LICSW
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6123 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-881-3700
Mailing Address - Fax:301-468-1862
Practice Address - Street 1:6123 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-881-3700
Practice Address - Fax:301-468-1862
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05414104100000X
DCLC302538104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD530196598OtherTRICARE
DCA2840020OtherBCBS OF DC
MD96557OtherMHN
MD101084000OtherMAGELLAN
MD235307OtherKAISER
MD54978OtherUBH
MD7267115OtherAETNA
MD61454502OtherBCBS OF MD
MD779608100Medicaid
MD54978OtherUBH