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General NPI Number Information
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NPI Number | 1720499288
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Entity Type | Organization
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Legal Business Name | TARA DEVINENI, LICSW, LLC
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Dates
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Enumeration Date | 05/17/2014
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Last Update Date | 05/17/2014
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Provider Practice Location Address
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Address Line | 3 WASHINGTON CIR NW SUITE 403
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City | WASHINGTON
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State | DC
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Zip | 20037-2356
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Country | US
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Telephone | 202-810-5786
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Fax |
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Provider Business Mailing Address
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Address Line | 3 WASHINGTON CIR NW SUITE 403
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City | WASHINGTON
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State | DC
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Zip | 20037-2356
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Country | US
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Telephone | 202-810-5786
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | TARA DEVINENI
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Credential | LICSW
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Telephone | 202-810-5786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50079309
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License Number State | DC
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