Provider Demographics
NPI:1407073828
Name:FRABOTTA, NICHOLAS PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:PETER
Last Name:FRABOTTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 WOODLEY RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3701
Mailing Address - Country:US
Mailing Address - Phone:202-244-6148
Mailing Address - Fax:202-244-6610
Practice Address - Street 1:5225 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 104
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2014
Practice Address - Country:US
Practice Address - Phone:202-244-6148
Practice Address - Fax:202-244-6610
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000169103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC491484Medicare PIN