Healthcare Provider Details

I. General information

NPI: 1154338523
Provider Name (Legal Business Name): ROBERT B SHEAVLY LICSW, DCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 17TH ST NW STE. 203
WASHINGTON DC
20009-2453
US

IV. Provider business mailing address

1700 17TH ST NW STE. 203
WASHINGTON DC
20009-2453
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-4900
  • Fax: 202-250-7990
Mailing address:
  • Phone: 202-232-4900
  • Fax: 202-250-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC302241
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: