Provider Demographics
NPI:1427364108
Name:OMAR, IHSAN S (LCSW-C, CST)
Entity type:Individual
Prefix:MS
First Name:IHSAN
Middle Name:S
Last Name:OMAR
Suffix:
Gender:F
Credentials:LCSW-C, CST
Other - Prefix:MS
Other - First Name:IHSAN
Other - Middle Name:S
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C, CST
Mailing Address - Street 1:1707 ROSEMONT AVE.
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:240-454-5647
Mailing Address - Fax:240-474-9172
Practice Address - Street 1:1707 ROSEMONT AVE.
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:240-454-5647
Practice Address - Fax:240-474-9172
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500779031041C0700X
MD131721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical