Provider Demographics
NPI:1982254538
Name:STIVEN, KIM EILEEN
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:EILEEN
Last Name:STIVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 CRATHIE LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1004
Mailing Address - Country:US
Mailing Address - Phone:240-472-1575
Mailing Address - Fax:
Practice Address - Street 1:64 NEW YORK AVE NE FL 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3328
Practice Address - Country:US
Practice Address - Phone:202-673-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500803681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical