Healthcare Provider Details

I. General information

NPI: 1467889519
Provider Name (Legal Business Name): HEATHER V GELDON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 MINNESOTA AVE NE
WASHINGTON DC
20019-3541
US

IV. Provider business mailing address

4017 MINNESOTA AVE NE
WASHINGTON DC
20019-3541
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-9202
  • Fax: 202-388-9209
Mailing address:
  • Phone: 202-388-9202
  • Fax: 202-388-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079910
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: