Individual provider Active NPI

Gabrielle Dietz, LCSWC

  • Social Worker
  • Columbia, MD
National Provider Identifier
1164060794
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
6410 Dobbin Rd Ste F
Columbia, MD 21045-4774
Phone
(301) 246-0718
NPI assigned
Dec 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 25316 MD
Social Worker 104100000X Primary

Addresses

Primary practice location

6410 Dobbin Rd Ste F
Columbia, MD 21045-4774

Mailing address

6410 Dobbin Rd Ste F
Columbia, MD 21045-4774

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20260507001258 MD Practitioner - Clinical Social Worker 5092283127 Reassigns benefits to 1 organization
I20260507001580 DC Practitioner - Clinical Social Worker 5092283127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Maryland School of Medicine, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Pittsburgh, PA 15251

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25316MDMDAmbulatory Care Pharmacist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1576195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1164060794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6410 DOBBIN RD STE F",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 DOBBIN RD STE F",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454774",
            "telephone_number": "301-246-0718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZ",
        "first_name": "GABRIELLE",
        "credential": "LCSWC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-13",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "25316",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.