Organization
CALDWELL PSYCHOTHERAPY CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT DAVID CALDWELL LICSW (OWNER)
(202) 298-8311
Entity
Organization
Contact information
Practice address
1984 ISAAC NEWTON SQ W STE 204, RESTON, VA 20190-5040
(703) 863-6140
Mailing address
1984 ISAAC NEWTON SQ W STE 204, RESTON, VA 20190-5040
(703) 863-6140
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
090400280
VA
1041C0700X
Clinical Social Worker
LC302452
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
766367ZBR9 G02714
MEDICARE PTAN
DC
01
—
766367ZBR9 G02714
MEDICARE PTAN
VA
Enumeration date
11/16/2007
Last updated
09/04/2015
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