Healthcare Provider Details

I. General information

NPI: 1902738008
Provider Name (Legal Business Name): KENDRA ETHERIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

3700 N CAPITOL ST NW
WASHINGTON DC
20011-8400
US

V. Phone/Fax

Practice location:
  • Phone: 301-728-1850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200001885
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: