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General NPI Number Information
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NPI Number | 1861771479
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Entity Type | Individual
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Provider Name | DOUGLAS LEE GOTEL MSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 50 E ST SE STE. 300
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City | WASHINGTON
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State | DC
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Zip | 20003-2620
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Country | US
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Telephone | 202-430-5461
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Fax |
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Provider Business Mailing Address
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Address Line | 5207 JAY ST NE
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City | WASHINGTON
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State | DC
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Zip | 20019-5529
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Country | US
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Telephone | 202-430-5461
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50078782
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License Number State | DC
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