Healthcare Provider Details

I. General information

NPI: 1710696380
Provider Name (Legal Business Name): MAUREEN IFEAGWU MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSI SERVICES INC 5820 DIX STREET NE
WASHINGTON DC
20019
US

IV. Provider business mailing address

5820 DIX ST NE
WASHINGTON DC
20019-6965
US

V. Phone/Fax

Practice location:
  • Phone: 240-898-5417
  • Fax:
Mailing address:
  • Phone: 202-547-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1360
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: