MEDICARE: DISTRICT OF COLUMBIA PUBLIC SCHOOLS

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	251S00000X	Community/Behavioral Health Agency	251S00000X	DC

General Provider Information

NPI Number	:	1063849917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTRICT OF COLUMBIA PUBLIC SCHOOLS

Provider Business Mailing Address
First Line	:	5536 SHALLOW RIVER RD
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-1567
Country	:	US
Telephone Number	:	301-943-9979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 Q ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5518
Country	:	US
Telephone Number	:	301-943-9979
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MS. TANYA JOY FLOWERS
Credential	:	MSW
Telephone Number	:	301-943-9979

Provider Enumeration Date	:	10/08/2013
Last Update Date	:	10/08/2013

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