Provider Demographics
NPI:1699257030
Name:HIMMELFARB, CHARLOTTE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:HIMMELFARB
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:240-864-6000
Mailing Address - Fax:
Practice Address - Street 1:831 UNIVERSITY BLVD EAST SUITE 14
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903
Practice Address - Country:US
Practice Address - Phone:301-891-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-01
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008088235Z00000X
MD08531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist