Healthcare Provider Details

I. General information

NPI: 1043057169
Provider Name (Legal Business Name): LAURA OTTENRITTER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 INDEPENDENCE AVE SE
WASHINGTON DC
20003-1733
US

IV. Provider business mailing address

6503 MORNING GLEN CT
ALEXANDRIA VA
22315-5028
US

V. Phone/Fax

Practice location:
  • Phone: 202-350-8680
  • Fax:
Mailing address:
  • Phone: 410-375-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50080192
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: