Provider Demographics
NPI:1275266058
Name:MARIA JOSE RENDON PH.D. LLC
Entity Type:Organization
Organization Name:MARIA JOSE RENDON PH.D. LLC
Other - Org Name:POTOMAC CBT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:240-200-0842
Mailing Address - Street 1:402 KING FARM BLVD
Mailing Address - Street 2:SUITE 125, #1102
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:786-281-4742
Mailing Address - Fax:
Practice Address - Street 1:12712 DEEP SPRING DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2355
Practice Address - Country:US
Practice Address - Phone:240-200-0842
Practice Address - Fax:301-590-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty