Provider Demographics
NPI:1720796683
Name:MASEMBE, GIDEON (CSW)
Entity Type:Individual
Prefix:
First Name:GIDEON
Middle Name:
Last Name:MASEMBE
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 GOOD HOPE RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5615
Mailing Address - Country:US
Mailing Address - Phone:202-558-2448
Mailing Address - Fax:
Practice Address - Street 1:12014 FAIRWAY MANOR CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5379
Practice Address - Country:US
Practice Address - Phone:240-906-9569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator