Provider Demographics
NPI:1508904111
Name:DANFORTH, LAVERNE VERONICA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LAVERNE
Middle Name:VERONICA
Last Name:DANFORTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MARTIN LUTHER KING JR AVE SE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7006
Mailing Address - Country:US
Mailing Address - Phone:202-466-1640
Mailing Address - Fax:202-610-1842
Practice Address - Street 1:1930 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7006
Practice Address - Country:US
Practice Address - Phone:202-466-1640
Practice Address - Fax:202-610-1842
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC302687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical