Healthcare Provider Details

I. General information

NPI: 1942601646
Provider Name (Legal Business Name): SASHA CLAYTON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 4TH ST NE
WASHINGTON DC
20002-3432
US

IV. Provider business mailing address

1234 4TH ST NE
WASHINGTON DC
20002-3432
US

V. Phone/Fax

Practice location:
  • Phone: 202-543-8477
  • Fax: 202-546-0869
Mailing address:
  • Phone: 202-543-8477
  • Fax: 202-546-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079521
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: