Provider Demographics
NPI:1245374883
Name:SAMUDA, JACQUELINE ISONIA (MSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ISONIA
Last Name:SAMUDA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9073 PICKWICK VILLAGE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3882
Mailing Address - Country:US
Mailing Address - Phone:301-439-2733
Mailing Address - Fax:
Practice Address - Street 1:932 HUNGERFORD DR STE 36B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1753
Practice Address - Country:US
Practice Address - Phone:240-461-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical