Healthcare Provider Details

I. General information

NPI: 1710609136
Provider Name (Legal Business Name): ELIZABETH BELANGER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE STE 440
WASHINGTON DC
20003-4424
US

IV. Provider business mailing address

3736 9TH ST NW
WASHINGTON DC
20010-1502
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5440
  • Fax:
Mailing address:
  • Phone: 610-662-0317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG200001642
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200003665
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: