Healthcare Provider Details

I. General information

NPI: 1790345486
Provider Name (Legal Business Name): PATHWAYS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2019
Last Update Date: 06/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SEWARD SQ SE
WASHINGTON DC
20003-6104
US

IV. Provider business mailing address

403 SEWARD SQ SE
WASHINGTON DC
20003-6104
US

V. Phone/Fax

Practice location:
  • Phone: 443-690-5857
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: AMBER SHRIVER
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 443-690-5857