Healthcare Provider Details

I. General information

NPI: 1336431006
Provider Name (Legal Business Name): SCRUPLES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 PENN AVE SE
WASHINGTON DC
20020-3865
US

IV. Provider business mailing address

2811 PENN AVE SE
WASHINGTON DC
20020-3865
US

V. Phone/Fax

Practice location:
  • Phone: 202-581-2455
  • Fax: 202-581-2459
Mailing address:
  • Phone: 202-581-2455
  • Fax: 202-581-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPRC 236
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPRC 236
License Number StateDC

VIII. Authorized Official

Name: MS. JOSEPHINE STATON
Title or Position: CLINICAL MANAGER
Credential: LPC
Phone: 202-581-2455