Basic Information
| Provider Information | |||||||||
| NPI: | 1548439276 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARYS CENTER FOR MATERNAL AND CHILD CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2333 ONTARIO RD NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200092627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024207031 | ||||||||
| FaxNumber: | 2023320541 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 KENNEDY ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200113010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025452068 | ||||||||
| FaxNumber: | 2025456610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2008 | ||||||||
| LastUpdateDate: | 09/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | GAVIRIA | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | ANDRES | ||||||||
| AuthorizedOfficialTitleorPosition: | RESEARCH ASSISTANT/ MENTAL HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 2025452068 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | PRC13970 | DC | Y | Agencies | Community/Behavioral Health |
No ID Information.