Provider Demographics
NPI:1366057945
Name:KERNAN, AMIHAN (LGSW)
Entity type:Individual
Prefix:
First Name:AMIHAN
Middle Name:
Last Name:KERNAN
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 SHERMAN AVE NW APT 355
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5459
Mailing Address - Country:US
Mailing Address - Phone:503-333-0923
Mailing Address - Fax:
Practice Address - Street 1:2616 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7715
Practice Address - Country:US
Practice Address - Phone:202-724-7847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker