Elizabeth Rose Black McClellan

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

26128 Issued in MD

Practice address

35 N Summit Ave
Gaithersburg, MD 20877-2921

Phone

(240) 740-4900

NPI assigned

Jan 9, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Elizabeth Rose Black Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Montgomery County Maryland Government

  • Primary Care Clinic/Center
  • Gaithersburg, MD
  • NPI 1053431106
  NPD
• Montgomery County Maryland Government

  • Dental Clinic/Center
  • Gaithersburg, MD
  • NPI 1770363475
  NPD

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1124564679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 E DIAMOND AVE STE H",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208775328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 N SUMMIT AVE",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772921",
            "telephone_number": "240-740-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK MCCLELLAN",
        "first_name": "ELIZABETH",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-09",
        "last_updated": "2020-09-01",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "26128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "BLACK",
            "middle_name": "ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jack Bilby, P.D.
• Elizabeth Bilodeau, RD, RDN
• Evonne D Bing, M.D.
• Mary Ann Lange Bishop, MD
• Marion Sabrina Bisselle
• David K. Black, D.D.S.
• Meghan Blair
• Susan B. Blair, LCMFT, CCDP
• Kya Lee Bland
• Blissful Care Alliance, LLC.

• All providers in Gaithersburg, MD
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; 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.