MEDICARE: CEPARTMENT OF MENTAL HEALTH

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	LC50078302	DC

General Provider Information

NPI Number	:	1427207059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEPARTMENT OF MENTAL HEALTH

Provider Business Mailing Address
First Line	:	3861 ALABAMA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-1001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3861 ALABAMA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-1001
Country	:	US
Telephone Number	:	202-645-3600
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISORY SOCIAL WORKER
Name	:	MS. SEAN B LOFTLIN-ARCHIE
Credential	:
Telephone Number	:	202-645-4460

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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Directions to “CEPARTMENT OF MENTAL HEALTH ” Practice Location

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