Provider Demographics
NPI:1538874581
Name:KLOPP, LARA (LMSW)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:KLOPP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WATERWAY CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3613
Mailing Address - Country:US
Mailing Address - Phone:540-809-2740
Mailing Address - Fax:
Practice Address - Street 1:4 WATERWAY CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-3613
Practice Address - Country:US
Practice Address - Phone:540-809-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW18301101Y00000X
MD32302101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD32302OtherSTATE OF MARYLAND
FLISW18301OtherSTATE OF FLORIDA