Healthcare Provider Details

I. General information

NPI: 1578385696
Provider Name (Legal Business Name): KYAUS JOSHUA WASHINGTON LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032
US

IV. Provider business mailing address

15 Q STREET NORTHWEST UNIT B
WASHINGTON DC
20001
US

V. Phone/Fax

Practice location:
  • Phone: 202-724-7666
  • Fax:
Mailing address:
  • Phone: 318-266-3758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLG200002842
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: