Healthcare Provider Details

I. General information

NPI: 1477892602
Provider Name (Legal Business Name): JAMISON DELEON LICSW, LCSW-C, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2639 CONNECTICUT AVE NW SUITE 251
WASHINGTON DC
20008-1537
US

IV. Provider business mailing address

2639 CONNECTICUT AVE NW SUITE 251
WASHINGTON DC
20008-1537
US

V. Phone/Fax

Practice location:
  • Phone: 877-674-2843
  • Fax: 877-674-2843
Mailing address:
  • Phone: 877-674-2843
  • Fax: 877-674-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009930
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18283
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50080268
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: