Healthcare Provider Details

I. General information

NPI: 1619346392
Provider Name (Legal Business Name): MARK REINER BORYS LPC, ATR-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 U ST NW, THIRD FLOOR
WASHINGTON DC
20009
US

IV. Provider business mailing address

2301 CHAMPLAIN ST NW APT 112
WASHINGTON DC
20009-8700
US

V. Phone/Fax

Practice location:
  • Phone: 202-888-5595
  • Fax:
Mailing address:
  • Phone: 202-888-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC14697
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC14697
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: