Healthcare Provider Details

I. General information

NPI: 1366979619
Provider Name (Legal Business Name): CAROLINE HEYWARD SPARKS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WISCONSIN CIR STE 700
BETHESDA MD
20815-7007
US

IV. Provider business mailing address

2 WISCONSIN CIR STE 700
BETHESDA MD
20815-7007
US

V. Phone/Fax

Practice location:
  • Phone: 202-236-3743
  • Fax:
Mailing address:
  • Phone: 202-236-3743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number01654
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number01654
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01654
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: