Healthcare Provider Details

I. General information

NPI: 1043721400
Provider Name (Legal Business Name): MICHAEL NEUSTADT LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CONNECTICUT AVE NW STE 300
WASHINGTON DC
20008-1162
US

IV. Provider business mailing address

6509 4TH AVE
TAKOMA PARK MD
20912-4843
US

V. Phone/Fax

Practice location:
  • Phone: 202-610-0066
  • Fax:
Mailing address:
  • Phone: 240-246-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC50081448
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: