Provider Demographics
NPI:1215236989
Name:SCHWIESOW, KIRSTEN (LGSW)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:SCHWIESOW
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E DIAMOND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-5327
Mailing Address - Country:US
Mailing Address - Phone:301-527-0854
Mailing Address - Fax:240-243-1061
Practice Address - Street 1:1835 UNIVERSITY BLVD E STE 220
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4657
Practice Address - Country:US
Practice Address - Phone:301-326-4356
Practice Address - Fax:301-326-4361
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical