Healthcare Provider Details

I. General information

NPI: 1306886098
Provider Name (Legal Business Name): YVONNE CEPERO LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE., N.W.
WASHINGTON DC
20307-5001
US

IV. Provider business mailing address

PO BOX 59048
WASHINGTON DC
20012-0048
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6378
  • Fax: 202-782-4922
Mailing address:
  • Phone: 301-933-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0008556
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBCD#29421
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: