Active NPI
Theodora Regina Proctor, MSW, LICSW, LCSW-C
- Clinical Social Worker
- Washington, DC
National Provider Identifier
1649427741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC302974
- Practice address
- 3035 Alabama Ave SE
Washington, DC 20020-3007 - Phone
- (202) 368-3542
- NPI assigned
- Aug 20, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC302974 | DC | Primary |
| Clinical Social Worker | 1041C0700X | 10678 | MD |
Addresses
Primary practice location
3035 Alabama Ave SE
Washington, DC 20020-3007
Mailing address
3035 Alabama Ave SE
Washington, DC 20020-3007
Phone (202) 368-3542
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC302974 | DC | MD | Clinical Social Worker |
| 10678 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244764800000",
"number": "1649427741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3035 ALABAMA AVE SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200203007",
"telephone_number": "202-368-3542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3035 ALABAMA AVE SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200203007",
"telephone_number": "202-368-3542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTOR",
"first_name": "THEODORA",
"middle_name": "REGINA",
"name_prefix": "Ms.",
"credential": "MSW, LICSW, LCSW-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-20",
"last_updated": "2009-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC302974",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "10678",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.