Provider Demographics
NPI:1013980523
Name:THAU, KENNETH RICHARD (MSW, JD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RICHARD
Last Name:THAU
Suffix:
Gender:M
Credentials:MSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10613 MONTROSE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4219
Mailing Address - Country:US
Mailing Address - Phone:202-320-5322
Mailing Address - Fax:
Practice Address - Street 1:10613 MONTROSE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4219
Practice Address - Country:US
Practice Address - Phone:301-493-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040032621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical