Basic Information
Provider Information
NPI: 1760717474
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWEATT
FirstName: LAYNE
MiddleName: BRYAN
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: WALTER REED ARMY MEDICAL
Address2: 6900 GEORGIA AVENUE, NORRTHWEST
City: WASHINGTON
State: DC
PostalCode: 203070001
CountryCode: US
TelephoneNumber: 2023561012
FaxNumber: 2023562720
Practice Location
Address1: WALTER REED ARMY MEDICAL
Address2: 6900 GEORGIA AVENUE, NORTHWEST
City: WASHINGTON
State: DC
PostalCode: 203070001
CountryCode: US
TelephoneNumber: 2023561012
FaxNumber: 2023562720
Other Information
ProviderEnumerationDate: 10/14/2009
LastUpdateDate: 10/14/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X0904005138VAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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