Provider Demographics
NPI:1114664893
Name:CORTOPASSI, CARLI SUSANNE
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:SUSANNE
Last Name:CORTOPASSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 CECIL PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3610
Mailing Address - Country:US
Mailing Address - Phone:202-235-4116
Mailing Address - Fax:
Practice Address - Street 1:2001 S ST NW STE 310
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1164
Practice Address - Country:US
Practice Address - Phone:202-235-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
22-003221700000X
DCLGPC00687101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist