Healthcare Provider Details

I. General information

NPI: 1679412415
Provider Name (Legal Business Name): BETHANY CIESLOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N QUINCY ST STE 601
ARLINGTON VA
22203-1729
US

IV. Provider business mailing address

2940 PALMER ST
OAKTON VA
22124-2624
US

V. Phone/Fax

Practice location:
  • Phone: 646-831-5374
  • Fax:
Mailing address:
  • Phone: 646-831-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024194505
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: