Provider Demographics
NPI:1821797812
Name:BOYS TOWN WASHINGTON DC, INC.
Entity Type:Organization
Organization Name:BOYS TOWN WASHINGTON DC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SHEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:531-355-8104
Mailing Address - Street 1:4801 SARGENT RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2841
Mailing Address - Country:US
Mailing Address - Phone:202-650-6361
Mailing Address - Fax:202-250-6362
Practice Address - Street 1:1300 CARAWAY CT STE 106
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5462
Practice Address - Country:US
Practice Address - Phone:120-265-0636
Practice Address - Fax:202-250-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty