Healthcare Provider Details

I. General information

NPI: 1871053827
Provider Name (Legal Business Name): JANET MINICHIELLO LCPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 08/30/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 CARROLL AVE STE 200B
TAKOMA PARK MD
20912-4437
US

IV. Provider business mailing address

255 CARROLL ST NW APT 562
WASHINGTON DC
20012-2093
US

V. Phone/Fax

Practice location:
  • Phone: 202-455-5679
  • Fax:
Mailing address:
  • Phone: 202-431-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATC214
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: