Healthcare Provider Details

I. General information

NPI: 1427188267
Provider Name (Legal Business Name): WALCHITOV ALEXIS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SUMMIT AVE KAISER PERMANENTE BEHAVIORAL HEALTH CENTER
KENSINGTON MD
20895-2422
US

IV. Provider business mailing address

2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-2500
  • Fax:
Mailing address:
  • Phone: 301-816-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08536
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: