Healthcare Provider Details

I. General information

NPI: 1811602758
Provider Name (Legal Business Name): NATHANIEL ROSS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 G ST NW STE 800
WASHINGTON DC
20005-6705
US

IV. Provider business mailing address

1200 G ST NW STE 800
WASHINGTON DC
20005-6705
US

V. Phone/Fax

Practice location:
  • Phone: 703-552-2722
  • Fax:
Mailing address:
  • Phone: 703-552-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: