Provider Demographics
NPI:1053798470
Name:HOTHA, MAMATA (LGSW, LSW)
Entity type:Individual
Prefix:
First Name:MAMATA
Middle Name:
Last Name:HOTHA
Suffix:
Gender:F
Credentials:LGSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15701 CRABBS BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2634
Mailing Address - Country:US
Mailing Address - Phone:917-574-1240
Mailing Address - Fax:301-365-2590
Practice Address - Street 1:15701 CRABBS BRANCH WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2634
Practice Address - Country:US
Practice Address - Phone:917-574-1240
Practice Address - Fax:301-365-2590
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903002152104100000X
MD20109104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker