Provider Demographics
NPI:1780893594
Name:NEUROTHERAPY CENTER OF WASHINGTON, INC.
Entity type:Organization
Organization Name:NEUROTHERAPY CENTER OF WASHINGTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ESTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-652-7175
Mailing Address - Street 1:7920 NORFOLK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2500
Mailing Address - Country:US
Mailing Address - Phone:301-652-7175
Mailing Address - Fax:301-652-7186
Practice Address - Street 1:7920 NORFOLK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2500
Practice Address - Country:US
Practice Address - Phone:301-652-7175
Practice Address - Fax:301-652-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD059131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD114545OtherKAISER PROVIDER NUMBER