Provider Demographics
NPI:1063202653
Name:VERMILYE, EILEEN GRADY (LICSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:GRADY
Last Name:VERMILYE
Suffix:
Gender:
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9309 RENSHAW DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2227
Mailing Address - Country:US
Mailing Address - Phone:202-666-9197
Mailing Address - Fax:
Practice Address - Street 1:9309 RENSHAW DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2227
Practice Address - Country:US
Practice Address - Phone:202-666-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3033851041C0700X
MD129591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical