Provider Demographics
NPI:1417719352
Name:DUCLEAN, LINE-CYNTHIA
Entity Type:Individual
Prefix:
First Name:LINE-CYNTHIA
Middle Name:
Last Name:DUCLEAN
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 1:11232 LEGATO WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-5049
Mailing Address - Country:US
Mailing Address - Phone:240-318-4302
Mailing Address - Fax:
Practice Address - Street 1:1910 MASSACHUSETTS AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2542
Practice Address - Country:US
Practice Address - Phone:202-673-9319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN200005815163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health