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General NPI Number Information
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NPI Number | 1598209132
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Entity Type | Individual
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Provider Name | KEVIN SEAN STAFFORD LICSW
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Gender | Male
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 2415 RANDOLPH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20018-3135
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Country | US
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Telephone | 202-813-5661
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Fax |
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Provider Business Mailing Address
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Address Line | 10230 PRINCE PL APT 208
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-1223
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Country | US
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Telephone | 202-813-5661
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | LG50080573
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LC200002128
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License Number State | DC
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