Healthcare Provider Details

I. General information

NPI: 1386073823
Provider Name (Legal Business Name): BENJAMIN DUKES LICSW, RDT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6218 GEORGIA AVENUE NW #1001
WASHINGTON DC
20011
US

IV. Provider business mailing address

6218 GEORGIA AVENUE NW #1001
WASHINGTON DC
20011
US

V. Phone/Fax

Practice location:
  • Phone: 202-579-9714
  • Fax:
Mailing address:
  • Phone: 202-579-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number739
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14940
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008459
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078630
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: