Healthcare Provider Details

I. General information

NPI: 1568890721
Provider Name (Legal Business Name): CHAZ KOHLRIESER MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. CHAZ HOLMON

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 UPSHUR ST NE
WASHINGTON DC
20018-3239
US

IV. Provider business mailing address

4201 CONNECTICUT AVE NW STE 300
WASHINGTON DC
20008-1162
US

V. Phone/Fax

Practice location:
  • Phone: 262-488-0027
  • Fax:
Mailing address:
  • Phone: 202-624-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19256
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC500080588
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: