NPIMap

Organization Active NPI

Expressive Therapy Center, LLC

  • Counseling Psychologist
  • Rockville, MD
National Provider Identifier
1013158310
Registry record updated Mar 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
03948 Issued in MD
Legal business name
EXPRESSIVE THERAPY CENTER, LLC
Practice address
14808 Physicians LN Ste 111
Rockville, MD 20850-3907
Phone
(301) 838-4112
Fax
(301) 838-0623
NPI assigned
Mar 16, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ivan Michael Nalibotsky
Title
Executive Director
Phone
(301) 838-4112

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X 03948 MD Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 11057 MD
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 12681 MD
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X MFC 26055 MD

Addresses

Primary practice location

14808 Physicians LN Ste 111
Rockville, MD 20850-3907

Mailing address

13153 Brushwood Way
Potomac, MD 20854-1025
Phone (301) 838-4112

National Provider Directory

National Provider Directory

Locations

14808 Physicians Ln
Ste 111
Rockville, MD 20850
Phone (301) 869-1017

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237161600000",
    "number": "1013158310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13153 BRUSHWOOD WAY",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208541025",
            "telephone_number": "301-838-4112",
            "fax_number": "301-838-0623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14808 PHYSICIANS LN STE 111",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503907",
            "telephone_number": "301-838-4112",
            "fax_number": "301-838-0623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPRESSIVE THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2009-03-16",
        "status": "A",
        "authorized_official_last_name": "NALIBOTSKY",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-838-4112",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MD",
            "license": "03948",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "11057",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "12681",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MD",
            "license": "MFC 26055",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.