Organization Name: | PROVIDENCE HEALTH SERVICES |
NPI Number: | 1609031632 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY SHERIDAN (AVP) |
Mailing Address: | 1150 Varnum St Ne Washington |
State: | DC US |
Postal Code: | 200172149 |
Phone Number: | 2022697000 |
Fax Number: | 2022697825 |
NPI Enumeration Date: | 07/18/2008 |
NPI Last Update Date: | 07/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | HFD01-0212 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |