Provider Demographics
NPI:1679690283
Name:CLINICAL, CULTURAL AND CONSULTING SERVICES, P.C.
Entity Type:Organization
Organization Name:CLINICAL, CULTURAL AND CONSULTING SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:MARIUS
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-234-1742
Mailing Address - Street 1:908 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2346
Mailing Address - Country:US
Mailing Address - Phone:202-234-1742
Mailing Address - Fax:
Practice Address - Street 1:908 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:SUITE 700
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2346
Practice Address - Country:US
Practice Address - Phone:202-234-1742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1342103TC0700X
DC147012083P0901X, 2084N0400X, 2084P0800X, 2084P0805X, 2084S0012X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Not Answered2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Not Answered208U00000XAllopathic & Osteopathic PhysiciansClinical PharmacologyGroup - Multi-Specialty