MEDICARE: PSYCHE & SOMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1659023414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHE & SOMA

Provider Business Mailing Address
First Line	:	1001 E CAPITOL ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-3905
Country	:	US
Telephone Number	:	202-552-1741
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 E CAPITOL ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-3906
Country	:	US
Telephone Number	:	202-552-1741
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. AURELIO OGILVIE
Credential	:	PHD
Telephone Number	:	202-552-1741

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	08/29/2023

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Directions to “PSYCHE & SOMA ” Practice Location

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