Healthcare Provider Details

I. General information

NPI: 1255630828
Provider Name (Legal Business Name): AMBER R. CARGILL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 K ST NW STE 605
WASHINGTON DC
20037-1810
US

IV. Provider business mailing address

2141 K ST NW STE 605
WASHINGTON DC
20037-1810
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-9844
  • Fax: 202-223-9845
Mailing address:
  • Phone: 202-223-9844
  • Fax: 202-223-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004353
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: