Provider Demographics
NPI:1902656929
Name:PROACTIVE PSYCHIATRY LC
Entity Type:Organization
Organization Name:PROACTIVE PSYCHIATRY LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL CLINICIAN & CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-640-5502
Mailing Address - Street 1:1629 K ST NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1718 CONNECTICUT AVE NW STE 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1148
Practice Address - Country:US
Practice Address - Phone:202-640-5502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty