Provider Demographics
NPI:1093169641
Name:IVES, CHARLOTTE (LICSW)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:IVES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 MICHIGAN AVE NE
Mailing Address - Street 2:WASHINGTON HOSPITAL CENTER TRINITY SQUARE, OUTPATIENT
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1095
Mailing Address - Country:US
Mailing Address - Phone:207-877-6333
Mailing Address - Fax:
Practice Address - Street 1:216 MICHIGAN AVE NE
Practice Address - Street 2:WASHINGTON HOSPITAL CENTER TRINITY SQUARE, OUTPATIENT
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1095
Practice Address - Country:US
Practice Address - Phone:207-877-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500806661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical