Provider Demographics
NPI:1659232353
Name:GROB, MICHELE (LMSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GROB
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 BLACKBURN LN STE 150
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-6127
Mailing Address - Country:US
Mailing Address - Phone:301-421-4241
Mailing Address - Fax:
Practice Address - Street 1:4000 BLACKBURN LN STE 150
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-6127
Practice Address - Country:US
Practice Address - Phone:301-421-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD34028104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker