Provider Demographics
NPI:1821602871
Name:PEZZELLE, MADDISON L (MSSW, LMSW)
Entity type:Individual
Prefix:MRS
First Name:MADDISON
Middle Name:L
Last Name:PEZZELLE
Suffix:
Gender:F
Credentials:MSSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 E WEST HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4426
Mailing Address - Country:US
Mailing Address - Phone:301-970-4001
Mailing Address - Fax:
Practice Address - Street 1:4350 E WEST HWY STE 200
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4426
Practice Address - Country:US
Practice Address - Phone:301-970-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD272151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical