Provider Demographics
NPI:1659466191
Name:CECKOWSKI, KEVIN ALLEN (SW LICSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ALLEN
Last Name:CECKOWSKI
Suffix:
Gender:M
Credentials:SW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 NORTH VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207
Mailing Address - Country:US
Mailing Address - Phone:703-469-2124
Mailing Address - Fax:
Practice Address - Street 1:WARD 48 NEPHROLOGY TRANSPLANT CLINIC WALTER REED ARMY
Practice Address - Street 2:6900 GEORGIA AVE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-5001
Practice Address - Country:US
Practice Address - Phone:202-782-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3026391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLC302639OtherLICSW, SOCIAL WORK