Healthcare Provider Details

I. General information

NPI: 1417719352
Provider Name (Legal Business Name): LINE-CYNTHIA DUCLEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MASSACHUSETTS AVE SE
WASHINGTON DC
20003-2542
US

IV. Provider business mailing address

11232 LEGATO WAY
SILVER SPRING MD
20901-5049
US

V. Phone/Fax

Practice location:
  • Phone: 202-673-9319
  • Fax:
Mailing address:
  • Phone: 240-318-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN200005815
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: