MEDICARE: DWW PSYCHOLOGICAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1043801152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DWW PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	4600 CONNECTICUT AVE NW STE 224
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-5702
Country	:	US
Telephone Number	:	301-520-2808
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 CONNECTICUT AVE NW STE 224
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-5702
Country	:	US
Telephone Number	:	301-520-2808
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER/CLINICAL PSYCHOLOGIST
Name	:	DR. KARIMAH WARE
Credential	:	PSY.D.
Telephone Number	:	301-520-2808

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	02/01/2021

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