Active NPI
Elizabeth Blocker Ebaugh, LCSW-C
- Clinical Social Worker
- Kensington, MD
National Provider Identifier
1538207709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 04880
- Practice address
- 3930 Knowles Ave
Ste.301
Kensington, MD 20895-2428 - Phone
- (301) 760-8798
- Fax
- (301) 312-8185
- NPI assigned
- Feb 1, 2007
- Last updated
- Aug 27, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 04880 | MD | Primary |
Addresses
Primary practice location
3930 Knowles Ave
Ste.301
Kensington, MD 20895-2428
Mailing address
3930 Knowles Ave
Ste 301
Kensington, MD 20895-2428
Phone (301) 760-8798
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04880 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409097600000",
"number": "1538207709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3930 KNOWLES AVE",
"address_2": "STE 301",
"city": "KENSINGTON",
"state": "MD",
"postal_code": "208952428",
"telephone_number": "301-760-8798",
"fax_number": "301-312-8185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3930 KNOWLES AVE",
"address_2": "STE.301",
"city": "KENSINGTON",
"state": "MD",
"postal_code": "208952428",
"telephone_number": "301-760-8798",
"fax_number": "301-312-8185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBAUGH",
"first_name": "ELIZABETH",
"middle_name": "BLOCKER",
"name_prefix": "Ms.",
"credential": "LCSW-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-01",
"last_updated": "2014-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "04880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kensington, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.