Healthcare Provider Details

I. General information

NPI: 1952576621
Provider Name (Legal Business Name): KUIPER NEUROBEHAVIORAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 E WEST HWY SUITE 309
BETHESDA MD
20814-4522
US

IV. Provider business mailing address

4405 E WEST HWY SUITE 309
BETHESDA MD
20814-4522
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-2487
  • Fax: 240-235-7023
Mailing address:
  • Phone: 301-656-2487
  • Fax: 240-235-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. GALENA KUIPER
Title or Position: PRESIDENT
Credential: LCSW-C
Phone: 301-656-2487