Basic Information
Provider Information
NPI: 1841222973
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WORRALL-FELDHAUSEN
FirstName: ROBERTA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5730 EXECUTIVE DR STE 230
Address2:  
City: CATONSVILLE
State: MD
PostalCode: 212281762
CountryCode: US
TelephoneNumber: 4104022379
FaxNumber: 4104693085
Practice Location
Address1: 3110 GRACEFIELD RD
Address2:  
City: SILVER SPRING
State: MD
PostalCode: 209041820
CountryCode: US
TelephoneNumber: 3015728340
FaxNumber: 3015728403
Other Information
ProviderEnumerationDate: 07/07/2006
LastUpdateDate: 03/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364SP0808XR119532MDY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsych/Mental Health

ID Information
IDTypeStateIssuerDescription
0943SE-643880-0101 CAREFIRST BCBS OF MDOTHER
830210101 EVERCAREOTHER
004101 CAREFRISTOTHER
0943ER-643880-0101 CAREFIRST BCBS OF MDOTHER
6438800101 BCBSOTHER
9680-001901 CAREFIRST BCBS OF DCOTHER


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