Provider Demographics
NPI:1417600933
Name:AMIRTHANAYAGAM, EASWARI ANITA (LGSW)
Entity Type:Individual
Prefix:
First Name:EASWARI
Middle Name:ANITA
Last Name:AMIRTHANAYAGAM
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WILSON BLVD APT 707
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2222
Mailing Address - Country:US
Mailing Address - Phone:202-910-7278
Mailing Address - Fax:
Practice Address - Street 1:2000 P ST NW STE 410
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6922
Practice Address - Country:US
Practice Address - Phone:202-910-7278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG2000013781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty