Provider Demographics
NPI:1982056321
Name:DIONISIO, JORGE
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:DIONISIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 AMITY CIR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1160
Mailing Address - Country:US
Mailing Address - Phone:240-364-4241
Mailing Address - Fax:240-261-5445
Practice Address - Street 1:8338 AMITY CIR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1160
Practice Address - Country:US
Practice Address - Phone:240-364-4241
Practice Address - Fax:240-261-5445
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker