Active NPI
Mark Boothe
- Clinical Social Worker
- Washington, DC
National Provider Identifier
1902219819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC303556
- Practice address
- 1629 K St NW
Washington, DC 20006-1602 - Phone
- (703) 754-0636
- NPI assigned
- Jun 9, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC303556 | DC | Primary |
Addresses
Primary practice location
1629 K St NW
Washington, DC 20006-1602
Mailing address
7230 Heritage Village Plaza Suite 202
Gainesville, VA 20155
Phone (703) 754-0636
Other names 1
- Mark Anthony Boothe
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 |
|---|---|---|---|
| LC303556 | DC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life Enrichment Counseling Center, Inc. | Clinical | Past | Accepting new patients |
| Marriage Healing Center, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Gainesville, VA
- NPI 1851517163
-
- Mental Health Counselor
- Gainesville, VA
- NPI 1518469246
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402272000000",
"number": "1902219819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7230 HERITAGE VILLAGE PLAZA SUITE 202",
"city": "GAINESVILLE",
"state": "VA",
"postal_code": "20155",
"telephone_number": "703-754-0636",
"fax_number": "703-754-0646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1629 K ST NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200061602",
"telephone_number": "703-754-0636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTHE",
"first_name": "MARK",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-09",
"last_updated": "2014-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC303556",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARK",
"last_name": "BOOTHE",
"middle_name": "ANTHONY",
"credential": "LICSW",
"code": "2",
"type": "Professional Name"
}
]
}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 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.