Basic Information
| Provider Information | |||||||||
| NPI: | 1417569211 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEACE BY PIECE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 MADISON ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200112311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027501246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1101 CONNECTICUT AVE NW | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200364303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027501246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2020 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | BIVENS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | KYLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL SOCIAL WORKER / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2027501246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW, LCSW-C | ||||||||
| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 047788688 | 05 | DC | MEDICAID |