Healthcare Provider Details

I. General information

NPI: 1245076900
Provider Name (Legal Business Name): FALLON EUELL STAMPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RHODE ISLAND AVE NW
WASHINGTON DC
20001-4153
US

IV. Provider business mailing address

1391 PENNSYLVANIA AVE SE UNIT 519
WASHINGTON DC
20003-3089
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-6100
  • Fax: 202-644-7024
Mailing address:
  • Phone: 717-979-6717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200002577
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: