Provider Demographics
NPI:1073490603
Name:NORDSTROM, ELISE (LMSW, LGSW)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:LMSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 ONYX CT
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1882
Mailing Address - Country:US
Mailing Address - Phone:202-374-8188
Mailing Address - Fax:801-421-9115
Practice Address - Street 1:7027 ONYX CT
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1882
Practice Address - Country:US
Practice Address - Phone:202-374-8188
Practice Address - Fax:801-421-9115
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG2000026531041C0700X
MD303021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical