Healthcare Provider Details

I. General information

NPI: 1770300295
Provider Name (Legal Business Name): JUSTIN HERBERT YAMPOLSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1940 BILTMORE ST NW APT 32
WASHINGTON DC
20009-1532
US

V. Phone/Fax

Practice location:
  • Phone: 202-624-0010
  • Fax:
Mailing address:
  • Phone: 843-513-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG200003092
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: