MEDICARE: CECELIA VAN ROOYEN LICSW

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	1041C0700X	Clinical Social Worker	LC50078963	DC

General Provider Information

NPI Number	:	1801104013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECELIA VAN ROOYEN LICSW

Provider Business Mailing Address
First Line	:	110 IRVING ST NW
Second Line	:	SUITE 2A38
City	:	WASHINGTON
State	:	DC
Zip	:	20010-3017
Country	:	US
Telephone Number	:	202-877-6464
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 MICHIGAN AVE NE
Second Line	:	SECOND FLOOR
City	:	WASHINGTON
State	:	DC
Zip	:	20017-1095
Country	:	US
Telephone Number	:	202-877-6464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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