Healthcare Provider Details

I. General information

NPI: 1972771632
Provider Name (Legal Business Name): CENTER FOR PROGRESSIVE DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 CONNECTICUT AVE NW SUITE 214
WASHINGTON DC
20015-1813
US

IV. Provider business mailing address

5225 CONNECTICUT AVE NW SUITE 214
WASHINGTON DC
20015-1813
US

V. Phone/Fax

Practice location:
  • Phone: 202-353-8184
  • Fax: 202-363-8367
Mailing address:
  • Phone: 202-353-8184
  • Fax: 202-363-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY 309
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY 309
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLI0200370
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 309
License Number StateDC

VIII. Authorized Official

Name: DR. DOUGLAS LABIER
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 202-363-8184