Provider Demographics
NPI:1336190339
Name:PEDERSEN, JOAN E (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:E
Last Name:PEDERSEN
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 1:933-D RUSSELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3290
Mailing Address - Country:US
Mailing Address - Phone:301-527-1382
Mailing Address - Fax:301-527-6158
Practice Address - Street 1:933-D RUSSELL AVENUE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879
Practice Address - Country:US
Practice Address - Phone:301-527-1382
Practice Address - Fax:301-527-6158
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-14
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491990Medicare ID - Type Unspecified