Provider Demographics
NPI:1376748632
Name:CHILDREN'S NATIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CHILDREN'S NATIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SUPPPORT SERVICES, NEURO.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CUSHNER WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LCSW-C OR LICSW
Authorized Official - Phone:202-884-5142
Mailing Address - Street 1:DEPT OF NEUROLOGY, CNMC 111 MICHIGAN AVE NW
Mailing Address - Street 2:111 MICHIGAN AVE NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2970
Mailing Address - Country:US
Mailing Address - Phone:202-884-5142
Mailing Address - Fax:202-884-2676
Practice Address - Street 1:(2ND ADDRESS) SHADY GROVE OFFICE
Practice Address - Street 2:14801 PHYSICIANS LANE
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:202-884-5142
Practice Address - Fax:202-884-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0720 (LCSW-C)281PC2000X
DCLC303058281PC2000X
MD14550 (PT)281PC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281PC2000XHospitalsChronic Disease HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD60457OtherINSURANCE #