Healthcare Provider Details

I. General information

NPI: 1891014627
Provider Name (Legal Business Name): JUSTINE LINETTE KALAS REEVES LICSW, D.PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CONNECTICUT AVE NW SOUTH ENTRANCE, SUITE 404
WASHINGTON DC
20008-2509
US

IV. Provider business mailing address

3000 CONNECTICUT AVE NW SOUTH ENTRANCE, SUITE 404
WASHINGTON DC
20008-2509
US

V. Phone/Fax

Practice location:
  • Phone: 202-360-0222
  • Fax:
Mailing address:
  • Phone: 202-360-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number50077844
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: