Healthcare Provider Details

I. General information

NPI: 1437950870
Provider Name (Legal Business Name): LIUBOV GRITSUNOV LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ALBEMARLE ST NW STE 5005TH
WASHINGTON DC
20016-1851
US

IV. Provider business mailing address

202 FLORIDA AVE NE APT 1409
WASHINGTON DC
20002-9048
US

V. Phone/Fax

Practice location:
  • Phone: 202-531-5385
  • Fax:
Mailing address:
  • Phone: 201-621-2196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200002987
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: