Provider Demographics
NPI:1811102544
Name:SHOWALTER, ROSS GORDON (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:GORDON
Last Name:SHOWALTER
Suffix:
Gender:M
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 1:6040 SOUTHPORT DR.
Mailing Address - Street 2:
Mailing Address - City:N. BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-493-4200
Mailing Address - Fax:301-493-6209
Practice Address - Street 1:6040 SOUTHPORT DR.
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-493-4200
Practice Address - Fax:301-493-6209
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12469104100000X
MD156881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker