Healthcare Provider Details

I. General information

NPI: 1285242172
Provider Name (Legal Business Name): AN X NGO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE STE 440
WASHINGTON DC
20003-4424
US

IV. Provider business mailing address

10410 GEORGIA AVE
SILVER SPRING MD
20902-4125
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5440
  • Fax:
Mailing address:
  • Phone: 240-224-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07307
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSYA00330
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: