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General NPI Number Information
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NPI Number | 1043721400
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Entity Type | Individual
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Provider Name | MICHAEL NEUSTADT LICSW
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Gender | Male
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 4201 CONNECTICUT AVE NW STE 300
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City | WASHINGTON
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State | DC
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Zip | 20008-1162
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Country | US
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Telephone | 202-610-0066
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Fax |
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Provider Business Mailing Address
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Address Line | 6509 4TH AVE
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City | TAKOMA PARK
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State | MD
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Zip | 20912-4843
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Country | US
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Telephone | 240-246-5786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC50081448
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License Number State | DC
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