Provider Demographics
NPI:1457904179
Name:POZO, JOSE ROBERT (LC11712)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ROBERT
Last Name:POZO
Suffix:
Gender:M
Credentials:LC11712
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8724
Mailing Address - Country:US
Mailing Address - Phone:301-838-4200
Mailing Address - Fax:
Practice Address - Street 1:200 WOOD HILL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8724
Practice Address - Country:US
Practice Address - Phone:301-838-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional