Provider Demographics
NPI:1679033021
Name:SALAZAR-LIZARDO, EMANUEL DE JESUS (LGSW)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:DE JESUS
Last Name:SALAZAR-LIZARDO
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4101
Mailing Address - Country:US
Mailing Address - Phone:202-765-3757
Mailing Address - Fax:
Practice Address - Street 1:4301 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5629
Practice Address - Country:US
Practice Address - Phone:202-576-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC500826151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical