Healthcare Provider Details

I. General information

NPI: 1609810498
Provider Name (Legal Business Name): CECILIA ROWLAND EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MARTIN LUTHER KING JR AVE SE CHILDRENS HEALTH CLINIC ANACOSTIA
WASHINGTON DC
20020-5702
US

IV. Provider business mailing address

PO BOX 37215
BALTIMORE MD
21297-3215
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-6900
  • Fax:
Mailing address:
  • Phone: 202-476-5000
  • Fax: 301-244-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002211
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1001218
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: