Healthcare Provider Details

I. General information

NPI: 1457532293
Provider Name (Legal Business Name): CENTRAL WASHINGTON PSYCHOTHERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 17TH ST NW APT 203
WASHINGTON DC
20009-2419
US

IV. Provider business mailing address

1700 17TH ST NW APT 203
WASHINGTON DC
20009-2419
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-4900
  • Fax: 202-250-7990
Mailing address:
  • Phone: 202-232-4900
  • Fax: 202-250-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number0008291
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC00302241
License Number StateDC

VIII. Authorized Official

Name: MR. ROBERT B SHEAVLY
Title or Position: DIRECTOR
Credential: MSW, LICSW, DCSW
Phone: 202-232-4900