Healthcare Provider Details

I. General information

NPI: 1114664893
Provider Name (Legal Business Name): CARLI SUSANNE CORTOPASSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S ST NW STE 310
WASHINGTON DC
20009-1164
US

IV. Provider business mailing address

1025 CECIL PL NW
WASHINGTON DC
20007-3610
US

V. Phone/Fax

Practice location:
  • Phone: 202-235-4116
  • Fax:
Mailing address:
  • Phone: 202-235-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number22-003
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGPC00687
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: