Provider Demographics
NPI:1366139172
Name:MORAN-GAITAN, NANCY A
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:MORAN-GAITAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 KENNEDY ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3137
Mailing Address - Country:US
Mailing Address - Phone:202-223-9630
Mailing Address - Fax:202-223-9632
Practice Address - Street 1:508 KENNEDY ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3137
Practice Address - Country:US
Practice Address - Phone:202-223-9630
Practice Address - Fax:202-223-9632
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health