Healthcare Provider Details

I. General information

NPI: 1184446809
Provider Name (Legal Business Name): NATHANIEL KIPERS LMSW, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NORTH GLEBE ROAD SUITE 303
ARLINGTON VA
22207
US

IV. Provider business mailing address

6841 MELROSE DRIVE
MCLEAN VA
22101
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-1290
  • Fax: 703-841-1315
Mailing address:
  • Phone: 703-955-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW141699
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903004267
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: